MEDICARE: DR. EDWIN S BROOKES DMD

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	21109	MA

General Provider Information

NPI Number	:	1629097662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWIN S BROOKES DMD

Provider Business Mailing Address
First Line	:	3970 N OAKLAND AVE
Second Line	:	UNIT 602
City	:	SHOREWOOD
State	:	WI
Zip	:	53211
Country	:	US
Telephone Number	:	414-212-8291
Fax Number	:	414-212-8471

Provider Business Practice Location Address
First Line	:	3970 N OAKLAND AVE STE 602
Second Line	:
City	:	SHOREWOOD
State	:	WI
Zip	:	53211-2265
Country	:	US
Telephone Number	:	414-212-8291
Fax Number	:	414-212-8471

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	09/14/2016

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