Healthcare Provider Details

I. General information

NPI: 1326363094
Provider Name (Legal Business Name): BROOKS DUNSTON DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 AMARILLO LANE BUFFALO LAKE BUSINESS PARK
SANFORD NC
27332
US

IV. Provider business mailing address

55 AMARILLO LANE
SANFORD NC
27332
US

V. Phone/Fax

Practice location:
  • Phone: 919-499-9950
  • Fax:
Mailing address:
  • Phone: 919-499-9950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7683
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8090
License Number StateNC

VIII. Authorized Official

Name: DR. SIDNEY ALAN BROOKS SR.
Title or Position: COOWNER
Credential: DDS
Phone: 919-499-9950