Provider Demographics
NPI:1265694590
Name:BROOKS, JEFFREY HAROLD (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:HAROLD
Last Name:BROOKS
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 1:875 UNION AVENUE
Mailing Address - Street 2:ROOM N328
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163
Mailing Address - Country:US
Mailing Address - Phone:901-448-6236
Mailing Address - Fax:
Practice Address - Street 1:875 UNION AVE
Practice Address - Street 2:ROOM N328
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3513
Practice Address - Country:US
Practice Address - Phone:901-448-6236
Practice Address - Fax:901-448-0548
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR35901223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery