Provider Demographics
NPI:1831583905
Name:BROOKS, BRIDGETTE JONES (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIDGETTE
Middle Name:JONES
Last Name:BROOKS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1678 MULKEY RD STE D
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1147
Mailing Address - Country:US
Mailing Address - Phone:770-448-8882
Mailing Address - Fax:
Practice Address - Street 1:1678 MULKEY RD STE D
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1147
Practice Address - Country:US
Practice Address - Phone:770-448-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10281122300000X
GADN0156021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist