Provider Demographics
NPI:1689893166
Name:BROOKS, CYNTHIA (DDS)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1461 GREENBRIER PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1697
Mailing Address - Country:US
Mailing Address - Phone:434-977-7080
Mailing Address - Fax:434-220-4804
Practice Address - Street 1:1461 GREENBRIER PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1697
Practice Address - Country:US
Practice Address - Phone:434-977-7080
Practice Address - Fax:434-220-4804
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010077111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice