Provider Demographics
NPI:1518840271
Name:ENGBARTH, BROOKE LYNAE (DT, RDH)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LYNAE
Last Name:ENGBARTH
Suffix:
Gender:F
Credentials:DT, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 STATE HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:SLAYTON
Mailing Address - State:MN
Mailing Address - Zip Code:56172-1845
Mailing Address - Country:US
Mailing Address - Phone:507-626-5061
Mailing Address - Fax:
Practice Address - Street 1:401 JEWETT ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-2605
Practice Address - Country:US
Practice Address - Phone:507-532-3104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDT188125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist