Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 5103 | OK |
NPI | 1598737108 |
---|---|
Provider Name | Dr. Brookes Fite Little |
First Address | Garvin, OK 74736-9722 |
Second Address | Idabel, OK 74745-7337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 29/06/2011 |