Provider Demographics
NPI:1578776316
Name:BROOKS, THEODORE HAMLIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:HAMLIN
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 1:108 CLARK LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-9557
Mailing Address - Country:US
Mailing Address - Phone:919-489-0770
Mailing Address - Fax:919-489-4947
Practice Address - Street 1:108 CLARK LAKE RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-9557
Practice Address - Country:US
Practice Address - Phone:919-489-0770
Practice Address - Fax:919-489-4947
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39821223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health