Provider Demographics
NPI:1154341824
Name:BROOKS, ANDREW REYNOLDS (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:REYNOLDS
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-2060
Mailing Address - Country:US
Mailing Address - Phone:304-727-4531
Mailing Address - Fax:304-727-4531
Practice Address - Street 1:2416 GRANT AVE
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-2060
Practice Address - Country:US
Practice Address - Phone:304-727-4531
Practice Address - Fax:304-727-4531
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2376122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist