Provider Demographics
NPI:1740272111
Name:BROOKS, AMY SUSAN (DDS MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:SUSAN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3341
Mailing Address - Country:US
Mailing Address - Phone:828-438-1010
Mailing Address - Fax:828-438-1044
Practice Address - Street 1:207 QUEEN ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3341
Practice Address - Country:US
Practice Address - Phone:828-438-1010
Practice Address - Fax:828-438-1044
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5982204E00000X
NC9900779204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U82945Medicare UPIN
2328012Medicare ID - Type Unspecified