Provider Demographics
NPI:1831276484
Name:BROOKS, TERRY MICHAEL JR (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:MICHAEL
Last Name:BROOKS
Suffix:JR
Gender:M
Credentials:DMD, MS
Other - Prefix:DR
Other - First Name:T.
Other - Middle Name:MICHAEL
Other - Last Name:BROOKS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DMD, MS
Mailing Address - Street 1:4643 CAMP COLEMAN ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-2838
Mailing Address - Country:US
Mailing Address - Phone:205-537-3008
Mailing Address - Fax:205-278-6745
Practice Address - Street 1:4643 CAMP COLEMAN ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-2838
Practice Address - Country:US
Practice Address - Phone:205-537-3008
Practice Address - Fax:205-278-6745
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL51361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics