Provider Demographics
NPI:1225114150
Name:MERRITT BROOKS, BRIDGET LYNN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:LYNN
Last Name:MERRITT BROOKS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:B
Other - Middle Name:
Other - Last Name:MERRITT BROOKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS PC
Mailing Address - Street 1:18509 PENNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221
Mailing Address - Country:US
Mailing Address - Phone:313-864-6856
Mailing Address - Fax:
Practice Address - Street 1:30400 TELEGRAPH RD
Practice Address - Street 2:SUITE 449
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025
Practice Address - Country:US
Practice Address - Phone:248-647-7550
Practice Address - Fax:248-647-4019
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist