Provider Demographics
NPI:1477753515
Name:DR AMY BROOKS DDS MD PHD PLLC
Entity Type:Organization
Organization Name:DR AMY BROOKS DDS MD PHD PLLC
Other - Org Name:DR AMY BROOKS DDS MD PHD PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MD,PHD,PLLC
Authorized Official - Phone:828-438-1010
Mailing Address - Street 1:320 S GREEN ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3527
Mailing Address - Country:US
Mailing Address - Phone:828-438-1010
Mailing Address - Fax:828-438-1044
Practice Address - Street 1:320 S GREEN ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3527
Practice Address - Country:US
Practice Address - Phone:828-438-1010
Practice Address - Fax:828-438-1044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC59821223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2328012Medicare PIN