Provider Demographics
NPI:1255484002
Name:BROOKS, WILLIAM EMMANUEL (DDS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EMMANUEL
Last Name:BROOKS
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 1:123 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:JAFFREY
Mailing Address - State:NH
Mailing Address - Zip Code:03452
Mailing Address - Country:US
Mailing Address - Phone:603-532-8720
Mailing Address - Fax:603-532-5618
Practice Address - Street 1:123 MAIN STREET
Practice Address - Street 2:
Practice Address - City:JAFFREY
Practice Address - State:NH
Practice Address - Zip Code:03452
Practice Address - Country:US
Practice Address - Phone:603-532-8720
Practice Address - Fax:603-532-5618
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2317122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAZHA019OtherBLUE CROSS BLUE SHIELD
1912894OtherUNITED CONCORDIA INSURANC
NH30304537Medicaid