Provider Demographics
NPI:1679316525
Name:BROOKS, HALEIGH FYALL (DMD)
Entity type:Individual
Prefix:DR
First Name:HALEIGH
Middle Name:FYALL
Last Name:BROOKS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2057 SW 246TH DR
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-5065
Mailing Address - Country:US
Mailing Address - Phone:407-733-0199
Mailing Address - Fax:
Practice Address - Street 1:14690 NW 151ST BLVD STE 20
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-5328
Practice Address - Country:US
Practice Address - Phone:386-462-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL290911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice