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NPI Code Detail

MEDICARE: DR. EDWARD MYLES BROOK D.D.S., P.C.

MEDICARE: DR. EDWARD MYLES BROOK D.D.S., P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry6179TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
174211245OTHERTXTAX ID #

General Provider Information

NPI Number : 1366541047
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWARD MYLES BROOK D.D.S., P.C.
Provider Business Mailing Address
First Line : 6800 WEST LOOP S
Second Line : SUITE 550
City : BELLAIRE
State : TX
Zip : 77401-4528
Country : US
Telephone Number : 713-795-5841
Fax Number : 713-795-5596
Provider Business Practice Location Address
First Line : 6800 WEST LOOP S
Second Line : SUITE 550
City : BELLAIRE
State : TX
Zip : 77401-4528
Country : US
Telephone Number : 713-795-5841
Fax Number : 713-795-5596
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2006
Last Update Date : 07/08/2007

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Directions to “ DR. EDWARD MYLES BROOK D.D.S., P.C.” Practice Location

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