Provider Demographics
NPI:1629097662
Name:BROOKES, EDWIN S (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:S
Last Name:BROOKES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3970 N OAKLAND AVE
Mailing Address - Street 2:UNIT 602
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211
Mailing Address - Country:US
Mailing Address - Phone:414-212-8291
Mailing Address - Fax:414-212-8471
Practice Address - Street 1:3970 N OAKLAND AVE STE 602
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2265
Practice Address - Country:US
Practice Address - Phone:414-212-8291
Practice Address - Fax:414-212-8471
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice