Provider Demographics
NPI:1043383284
Name:BROOKS, RICHARD FERRELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:FERRELL
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:R
Other - Middle Name:FERRELL
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS PC
Mailing Address - Street 1:101 NORTHSIDE DR
Mailing Address - Street 2:C
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1724
Mailing Address - Country:US
Mailing Address - Phone:229-247-2225
Mailing Address - Fax:229-247-2295
Practice Address - Street 1:101 NORTHSIDE DR
Practice Address - Street 2:C
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1724
Practice Address - Country:US
Practice Address - Phone:229-247-2225
Practice Address - Fax:229-247-2295
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN007027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist