Provider Demographics
NPI:1427589241
Name:DAVID P BROCK DMD, MS, INC
Entity Type:Organization
Organization Name:DAVID P BROCK DMD, MS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-373-3703
Mailing Address - Street 1:40 DORMODY CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2908
Mailing Address - Country:US
Mailing Address - Phone:831-373-3703
Mailing Address - Fax:
Practice Address - Street 1:40 DORMODY CT
Practice Address - Street 2:SUITE A
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2908
Practice Address - Country:US
Practice Address - Phone:831-373-3703
Practice Address - Fax:831-324-4075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty