Provider Demographics
NPI:1255687216
Name:ANTHONY R BROCK DMD PLLC
Entity Type:Organization
Organization Name:ANTHONY R BROCK DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-477-6555
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-4320
Mailing Address - Country:US
Mailing Address - Phone:360-683-5700
Mailing Address - Fax:360-683-7132
Practice Address - Street 1:321 N SEQUIM AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3457
Practice Address - Country:US
Practice Address - Phone:360-683-5700
Practice Address - Fax:360-683-7132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty