MEDICARE: DR. NICHOLAS CORNELL BROOKS DDS

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
1	1223G0001X	General Practice Dentistry	10194	TN

General Provider Information

NPI Number	:	1326404963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS CORNELL BROOKS DDS

Provider Business Mailing Address
First Line	:	2410 CHELSEA AVENUE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38108
Country	:	US
Telephone Number	:	901-458-1118
Fax Number	:

Provider Business Practice Location Address
First Line	:	2410 CHELSEA AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38108-1515
Country	:	US
Telephone Number	:	901-458-1118
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2016
Last Update Date	:	05/27/2017

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