Provider Demographics
NPI:1700051638
Name:TIM J. BROOKS DDS INC.
Entity Type:Organization
Organization Name:TIM J. BROOKS DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-752-0600
Mailing Address - Street 1:12448 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8601
Mailing Address - Country:US
Mailing Address - Phone:405-752-0600
Mailing Address - Fax:405-751-6362
Practice Address - Street 1:12448 SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8601
Practice Address - Country:US
Practice Address - Phone:405-752-0600
Practice Address - Fax:405-751-6362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5217122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty