Provider Demographics
NPI:1477878734
Name:BROOKS, KEVIN GARRETT (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:GARRETT
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MARION OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34473-2212
Mailing Address - Country:US
Mailing Address - Phone:352-347-2333
Mailing Address - Fax:352-347-4150
Practice Address - Street 1:125 MARION OAKS BLVD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34473-2212
Practice Address - Country:US
Practice Address - Phone:352-347-2333
Practice Address - Fax:352-347-4150
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN90391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice