Provider Demographics
NPI:1982449914
Name:BROOKWOOD DENTISTRY, LLC
Entity type:Organization
Organization Name:BROOKWOOD DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR TEAM LEAD
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:1569 JANMAR RD STE A
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5780
Mailing Address - Country:US
Mailing Address - Phone:770-979-7923
Mailing Address - Fax:678-990-6954
Practice Address - Street 1:1569 JANMAR RD STE A
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5780
Practice Address - Country:US
Practice Address - Phone:770-979-7923
Practice Address - Fax:678-990-6954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty