Provider Demographics
NPI:1033679089
Name:BRK, PLLC
Entity Type:Organization
Organization Name:BRK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE ADVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-633-0814
Mailing Address - Street 1:700 S MUSTANG RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6777
Mailing Address - Country:US
Mailing Address - Phone:405-494-7227
Mailing Address - Fax:
Practice Address - Street 1:7120 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-3315
Practice Address - Country:US
Practice Address - Phone:405-681-6601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-24
Last Update Date:2019-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty