Provider Demographics
NPI:1417244401
Name:BROOKS, CHARLES BRANDTEN (DMD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:BRANDTEN
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 1:436 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361
Mailing Address - Country:US
Mailing Address - Phone:859-987-5550
Mailing Address - Fax:859-987-2465
Practice Address - Street 1:436 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361
Practice Address - Country:US
Practice Address - Phone:859-987-5550
Practice Address - Fax:859-987-2465
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9061122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist