Provider Demographics
NPI:1730283391
Name:BROOKS, GREGORY M (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:M
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:903 N SAN FERNANDO BLVD
Mailing Address - Street 2:STE #1
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504
Mailing Address - Country:US
Mailing Address - Phone:818-841-0685
Mailing Address - Fax:818-843-6613
Practice Address - Street 1:903 N SAN FERNANDO BLVD
Practice Address - Street 2:STE #1
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504
Practice Address - Country:US
Practice Address - Phone:818-841-0685
Practice Address - Fax:818-843-6613
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33251122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist