Provider Demographics
NPI:1285773374
Name:BROOKS, PAUL CEPHUS III (DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:CEPHUS
Last Name:BROOKS
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3600 LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2938
Mailing Address - Country:US
Mailing Address - Phone:502-585-3926
Mailing Address - Fax:502-585-1029
Practice Address - Street 1:3600 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2938
Practice Address - Country:US
Practice Address - Phone:502-585-3926
Practice Address - Fax:502-585-1029
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY62471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice