Provider Demographics
NPI:1336202084
Name:BROOKS, ELLIOT MORTON JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:MORTON JOSEPH
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 1:1 EVANS RD
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5963
Mailing Address - Country:US
Mailing Address - Phone:609-653-2242
Mailing Address - Fax:
Practice Address - Street 1:1634 NEW RD
Practice Address - Street 2:EASTERN DENTAL OF NORTHFIELD
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1108
Practice Address - Country:US
Practice Address - Phone:609-677-1589
Practice Address - Fax:609-677-1593
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI006859011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice