Provider Demographics
NPI:1376646448
Name:BROCK, LARRY RICHARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:RICHARD
Last Name:BROCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 WESTHEIMER RD
Mailing Address - Street 2:APT. 2402
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-4812
Mailing Address - Country:US
Mailing Address - Phone:724-513-2416
Mailing Address - Fax:
Practice Address - Street 1:1454 CAMPBELL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-4604
Practice Address - Country:US
Practice Address - Phone:724-513-2416
Practice Address - Fax:281-265-1850
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX237951223G0001X
PADS018023L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice