Serese Cannon Brooks, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN23213 Issued in FL

Practice address

4930 E Lake Mary Blvd
Sanford, FL 32771-5003

Phone

(407) 322-8645

Fax

(407) 305-7048

NPI assigned

May 18, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Serese Myers Cannon Professional name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Amp Oral and Maxillofacial Surgery, PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Orlando, FL
  • NPI 1144812348
  NPD (past)
• Nona Dentists, PA

  dba Nona Dentists

  • Dentist
  • Lake Nona, Orlando, FL
  • NPI 1427574151
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622073600000",
    "number": "1285842658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4930 E LAKE MARY BLVD",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327715003",
            "telephone_number": "407-322-8645",
            "fax_number": "407-305-7048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4930 E LAKE MARY BLVD",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327715003",
            "telephone_number": "407-322-8645",
            "fax_number": "407-305-7048"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12711 Narcoossee Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328326991",
            "country_code": "US",
            "telephone_number": "407-627-1235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "SERESE",
        "middle_name": "CANNON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-18",
        "last_updated": "2021-05-27",
        "certification_date": "2021-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN23213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SERESE",
            "last_name": "MYERS CANNON",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Brightstart Pediatrics, LLC (BrightStart Pediatrics)
• Brightstart Pediatrics,LLC (BrightStart Pediatrics)
• Lisamarie Brignoni, M.A. CCC-SLP
• Sharaleen Peycke Broderick
• Blondell Brookes
• Alajade Brown
• Barbara Brown, COTA/L
• Randall C Brown, DMD
• Rolanda Alethia Brown, MD, MPH
• Emily Nicole Brubach, BS

• Pediatric Dentistry in Sanford, FL
• Providers in Sanford, FL by specialty
• Pediatric Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.