MEDICARE: TIM J. BROOKS DDS INC.

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	5217	OK

General Provider Information

NPI Number	:	1700051638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIM J. BROOKS DDS INC.

Provider Business Mailing Address
First Line	:	12448 SAINT ANDREWS DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8601
Country	:	US
Telephone Number	:	405-752-0600
Fax Number	:	405-751-6362

Provider Business Practice Location Address
First Line	:	12448 SAINT ANDREWS DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8601
Country	:	US
Telephone Number	:	405-752-0600
Fax Number	:	405-751-6362

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TIM JACK BROOKS
Credential	:	DDS
Telephone Number	:	405-752-0600

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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