Provider Demographics
NPI:1376557108
Name:BROOKS, WILLIAM LOUIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LOUIS
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 1:118 S BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837
Mailing Address - Country:US
Mailing Address - Phone:517-627-4027
Mailing Address - Fax:517-627-6121
Practice Address - Street 1:118 S BRIDGE ST
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837
Practice Address - Country:US
Practice Address - Phone:517-627-4027
Practice Address - Fax:517-627-6121
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI8305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist