Provider Demographics
NPI:1235705039
Name:HUMMEL, BROOKS (DDS)
Entity type:Individual
Prefix:DR
First Name:BROOKS
Middle Name:
Last Name:HUMMEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 HELIOS AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-1550
Mailing Address - Country:US
Mailing Address - Phone:318-512-3959
Mailing Address - Fax:
Practice Address - Street 1:4607 SHERWOOD COMMON BLVD BLDG 2
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4892
Practice Address - Country:US
Practice Address - Phone:225-924-7367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA70031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics