Healthcare Provider Details

I. General information

NPI: 1255484002
Provider Name (Legal Business Name): WILLIAM EMMANUEL BROOKS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 MAIN STREET
JAFFREY NH
03452
US

IV. Provider business mailing address

123 MAIN STREET
JAFFREY NH
03452
US

V. Phone/Fax

Practice location:
  • Phone: 603-532-8720
  • Fax: 603-532-5618
Mailing address:
  • Phone: 603-532-8720
  • Fax: 603-532-5618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2317
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: