Provider Demographics
NPI:1346424199
Name:BROOKE R. SNOWDEN, DDS, PC
Entity Type:Organization
Organization Name:BROOKE R. SNOWDEN, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:RACHELL
Authorized Official - Last Name:SNOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-681-6668
Mailing Address - Street 1:7200 S PENN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-3336
Mailing Address - Country:US
Mailing Address - Phone:405-681-6668
Mailing Address - Fax:405-682-6609
Practice Address - Street 1:7200 S PENN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-3336
Practice Address - Country:US
Practice Address - Phone:405-681-6668
Practice Address - Fax:405-682-6609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5798122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty