=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649845132
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BROOKE COY DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2021
-----------------------------------------------------
Last Update Date | 02/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7810 E 121ST ST S
-----------------------------------------------------
City | BIXBY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74008-2304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-299-7750
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8769 S 33RD WEST AVE
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74132-3533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 7422
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------