Provider Demographics
NPI:1114918844
Name:BROOKS, PERRY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:L
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 W. GORE BLVD., SUITE B.
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505
Mailing Address - Country:US
Mailing Address - Phone:580-357-0888
Mailing Address - Fax:580-248-1860
Practice Address - Street 1:3617 W. GORE BLVD., SUITE B
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505
Practice Address - Country:US
Practice Address - Phone:580-357-0888
Practice Address - Fax:580-248-1860
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK52161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU58633Medicare UPIN