Provider Demographics
NPI:1750584298
Name:BROOKS, KENNETH E II (DDS)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:E
Last Name:BROOKS
Suffix:II
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 1:5407 S INGLESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-5013
Mailing Address - Country:US
Mailing Address - Phone:773-955-2393
Mailing Address - Fax:
Practice Address - Street 1:676 N MICHIGAN AVE
Practice Address - Street 2:SUITE 3500
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2883
Practice Address - Country:US
Practice Address - Phone:312-274-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019017514122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist