Provider Demographics
NPI:1063536563
Name:STEPHEN A. BROOKS, D.D.S., P.C.
Entity type:Organization
Organization Name:STEPHEN A. BROOKS, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-265-3471
Mailing Address - Street 1:102 WALNUT ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-1121
Mailing Address - Country:US
Mailing Address - Phone:423-265-3471
Mailing Address - Fax:423-265-3103
Practice Address - Street 1:102 WALNUT ST
Practice Address - Street 2:SUITE F
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-1121
Practice Address - Country:US
Practice Address - Phone:423-265-3471
Practice Address - Fax:423-265-3103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000019081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty