Provider Demographics
NPI:1972708238
Name:WOOD, BROOKE M (DDS)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:M
Last Name:WOOD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9804 BLUEBONNET BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-6442
Mailing Address - Country:US
Mailing Address - Phone:225-796-1969
Mailing Address - Fax:
Practice Address - Street 1:9804 BLUEBONNET BLVD
Practice Address - Street 2:STE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-6442
Practice Address - Country:US
Practice Address - Phone:225-796-1969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA58461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1858463Medicaid