MEDICARE: DR. LARRY THOMAS BROOKS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN4861	FL

General Provider Information

NPI Number	:	1164728606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY THOMAS BROOKS DDS

Provider Business Mailing Address
First Line	:	4306 W EL PRADO BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-8405
Country	:	US
Telephone Number	:	813-839-8730
Fax Number	:	813-839-4707

Provider Business Practice Location Address
First Line	:	4306 W EL PRADO BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-8405
Country	:	US
Telephone Number	:	813-839-8730
Fax Number	:	813-839-4707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2011
Last Update Date	:	02/01/2011

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