Healthcare Provider Details

I. General information

NPI: 1598737108
Provider Name (Legal Business Name): BROOKES FITE LITTLE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 E LINCOLN RD
IDABEL OK
74745-7337
US

IV. Provider business mailing address

RR 1 BOX 114
GARVIN OK
74736-9722
US

V. Phone/Fax

Practice location:
  • Phone: 580-286-2600
  • Fax: 580-286-1172
Mailing address:
  • Phone: 580-286-2600
  • Fax: 580-286-1172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number5103
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: