Provider Demographics
NPI:1114023975
Name:BROOKS, SIDNEY SR (DDS)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:BROOKS
Suffix:SR
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 1:55 AMARILLO
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-0000
Mailing Address - Country:US
Mailing Address - Phone:919-499-9950
Mailing Address - Fax:919-499-9949
Practice Address - Street 1:55 AMARILLO LANE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-0000
Practice Address - Country:US
Practice Address - Phone:919-499-9950
Practice Address - Fax:919-499-9949
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC76831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900692Medicaid