Paul Jeffrey Brooks, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2901016571 Issued in MI

Practice address

2140 Lake Michigan Dr NW
Grand Rapids, MI 49504-4785

Phone

(616) 735-2870

Fax

(616) 735-2871

NPI assigned

Oct 4, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Oral & Maxillofacial Surgery Associates of Western Michigan PLC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Grand Rapids, MI
  • NPI 1598772626

  Oral and Maxillofacial Surgery

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053406728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2140 LAKE MICHIGAN DR NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495044785",
            "telephone_number": "616-735-2870",
            "fax_number": "616-735-2871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2140 LAKE MICHIGAN DR NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495044785",
            "telephone_number": "616-735-2870",
            "fax_number": "616-735-2871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "PAUL",
        "middle_name": "JEFFREY",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "2901016571",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0D111530",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSD",
            "identifier": "165710",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carly Christine Brooks, MA, LLPC
• Derek Brooks Jr.
• Ellen Brooks
• Emily Carolyn Brooks
• Melissa Lynn Brooks, FNP
• Sara Frances Brooks, REHAB TECHNICIAN
• Sheria Brooks
• Valrie Jean Brooks
• Felicia Rose Bross, M.A., CCC-SLP
• Alexandrea Brouwer

• Oral and Maxillofacial Surgery (Dentist) in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.