Provider Demographics
NPI:1366442394
Name:BROOKS, W. TIMOTHY (DMD)
Entity type:Individual
Prefix:DR
First Name:W. TIMOTHY
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WHITESPORT DR SW
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6451
Mailing Address - Country:US
Mailing Address - Phone:256-883-8008
Mailing Address - Fax:256-883-1878
Practice Address - Street 1:500 WHITESPORT DR SW
Practice Address - Street 2:SUITE 3
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6451
Practice Address - Country:US
Practice Address - Phone:256-883-8008
Practice Address - Fax:256-883-1878
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL37391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice