Active NPI
Edwin S Brookes, DMD
- General Practice Dentistry
- Shorewood, WI
National Provider Identifier
1629097662
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 21109
- Practice address
- 3970 N Oakland Ave Ste 602
Shorewood, WI 53211-2265 - Phone
- (414) 212-8291
- Fax
- (414) 212-8471
- NPI assigned
- Jul 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 21109 | MA | Primary |
Addresses
Primary practice location
3970 N Oakland Ave Ste 602
Shorewood, WI 53211-2265
Mailing address
3970 N Oakland Ave
Unit 602
Shorewood, WI 53211
Phone (414) 212-8291
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21109 | MA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473811200000",
"number": "1629097662",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3970 N OAKLAND AVE",
"address_2": "UNIT 602",
"city": "SHOREWOOD",
"state": "WI",
"postal_code": "53211",
"telephone_number": "414-212-8291",
"fax_number": "414-212-8471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3970 N OAKLAND AVE STE 602",
"city": "SHOREWOOD",
"state": "WI",
"postal_code": "532112265",
"telephone_number": "414-212-8291",
"fax_number": "414-212-8471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROOKES",
"first_name": "EDWIN",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-19",
"last_updated": "2016-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "21109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shorewood, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.