Provider Demographics
NPI:1437136447
Name:BROCKETT, STEVEN CLAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CLAY
Last Name:BROCKETT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6618 S CREEKSTONE ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-8807
Mailing Address - Country:US
Mailing Address - Phone:907-957-1945
Mailing Address - Fax:
Practice Address - Street 1:1 EDIZ HOOK ROAD
Practice Address - Street 2:USCG AIRSTA/SFO PORT ANGELES
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-2201
Practice Address - Country:US
Practice Address - Phone:360-417-5880
Practice Address - Fax:360-417-5899
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice