MEDICARE: DR. TIM JACK BROOKS DDS

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	5217	OK

General Provider Information

NPI Number	:	1912029703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIM JACK BROOKS DDS

Provider Business Mailing Address
First Line	:	4401 W MEMORIAL RD
Second Line	:	STE 134
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1787
Country	:	US
Telephone Number	:	405-752-0600
Fax Number	:

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	02/02/2016

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