MEDICARE: BRK, PLLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1033679089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRK, PLLC

Provider Business Mailing Address
First Line	:	700 S MUSTANG RD
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-6777
Country	:	US
Telephone Number	:	405-494-7227
Fax Number	:

Provider Business Practice Location Address
First Line	:	7120 S PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-3315
Country	:	US
Telephone Number	:	405-681-6601
Fax Number	:

Authorized Official
Title or Position	:	INSURANCE ADVISOR
Name	:	KRISTEN JOHNSON
Credential	:
Telephone Number	:	405-633-0814

Provider Enumeration Date	:	03/24/2019
Last Update Date	:	03/24/2019

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