Healthcare Provider Details

I. General information

NPI: 1336367382
Provider Name (Legal Business Name): C. EDWARD BROOKS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11226 W POINT DR SUITE B
KNOXVILLE TN
37934-2837
US

IV. Provider business mailing address

11226 W POINT DR SUITE B
KNOXVILLE TN
37934-2837
US

V. Phone/Fax

Practice location:
  • Phone: 865-675-5646
  • Fax: 865-675-5646
Mailing address:
  • Phone: 865-675-5646
  • Fax: 865-675-5646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3145
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: