Provider Demographics
NPI:1477968105
Name:BROOKS, SETH RUSSELL (DDS)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:RUSSELL
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 1:3441 W ROCK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2435
Mailing Address - Country:US
Mailing Address - Phone:405-329-3500
Mailing Address - Fax:405-329-3501
Practice Address - Street 1:3441 W ROCK CREEK RD
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2435
Practice Address - Country:US
Practice Address - Phone:405-329-3500
Practice Address - Fax:405-329-3501
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012223A1223G0001X
OKLDR140096390200000X
OK65811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program