Provider Demographics
NPI:1366541047
Name:BROOK, EDWARD MYLES (DDS, PC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MYLES
Last Name:BROOK
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 WEST LOOP S
Mailing Address - Street 2:SUITE 550
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4528
Mailing Address - Country:US
Mailing Address - Phone:713-795-5841
Mailing Address - Fax:713-795-5596
Practice Address - Street 1:6800 WEST LOOP S
Practice Address - Street 2:SUITE 550
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4528
Practice Address - Country:US
Practice Address - Phone:713-795-5841
Practice Address - Fax:713-795-5596
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74211245OtherTAX ID #