MEDICARE: SETH RUSSELL BROOKS D.D.S.

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	12012223A	IN
2	390200000X	Student in an Organized Health Care Education/Training Program	LDR140096	OK
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	6581	OK

General Provider Information

NPI Number	:	1477968105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SETH RUSSELL BROOKS D.D.S.

Provider Business Mailing Address
First Line	:	3441 W ROCK CREEK RD
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73072-2435
Country	:	US
Telephone Number	:	405-329-3500
Fax Number	:	405-329-3501

Provider Business Practice Location Address
First Line	:	3441 W ROCK CREEK RD
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73072-2435
Country	:	US
Telephone Number	:	405-329-3500
Fax Number	:	405-329-3501

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

Provider Enumeration Date	:	06/20/2014
Last Update Date	:	07/09/2019

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