Provider Demographics
NPI:1700999380
Name:GARY E BROOKS DMD INC
Entity type:Organization
Organization Name:GARY E BROOKS DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-876-3911
Mailing Address - Street 1:247 SW LAMSON ST.
Mailing Address - Street 2:PO BOX 569
Mailing Address - City:WILLAMINA
Mailing Address - State:OR
Mailing Address - Zip Code:97396-0569
Mailing Address - Country:US
Mailing Address - Phone:503-876-3911
Mailing Address - Fax:503-876-8911
Practice Address - Street 1:247 LAMSON ST.
Practice Address - Street 2:
Practice Address - City:WILLAMINA
Practice Address - State:OR
Practice Address - Zip Code:97396-0569
Practice Address - Country:US
Practice Address - Phone:503-876-3911
Practice Address - Fax:503-876-8911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4599122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty