1225114150 NPI number — MRS. BRIDGET LYNN MERRITT BROOKS DDS

Table of content: MRS. BRIDGET LYNN MERRITT BROOKS DDS (NPI 1225114150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225114150 NPI number — MRS. BRIDGET LYNN MERRITT BROOKS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERRITT BROOKS
Provider First Name:
BRIDGET
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MERRITT BROOKS
Provider Other First Name:
B
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS PC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1225114150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18509 PENNINGTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-864-6856
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30400 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
SUITE 449
Provider Business Practice Location Address City Name:
BINGHAM FARMS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-647-7550
Provider Business Practice Location Address Fax Number:
248-647-4019
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2901016615 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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