Provider Demographics
NPI:1285842658
Name:BROOKS, SERESE CANNON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SERESE
Middle Name:CANNON
Last Name:BROOKS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SERESE
Other - Middle Name:
Other - Last Name:MYERS CANNON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4930 E LAKE MARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-5003
Mailing Address - Country:US
Mailing Address - Phone:407-322-8645
Mailing Address - Fax:407-305-7048
Practice Address - Street 1:4930 E LAKE MARY BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-5003
Practice Address - Country:US
Practice Address - Phone:407-322-8645
Practice Address - Fax:407-305-7048
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN232131223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry