Provider Demographics
NPI:1467567198
Name:DEAL, BROCK (DDS)
Entity Type:Individual
Prefix:DR
First Name:BROCK
Middle Name:
Last Name:DEAL
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 1:4344 WOODLANDS BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2801
Mailing Address - Country:US
Mailing Address - Phone:303-328-3979
Mailing Address - Fax:
Practice Address - Street 1:4344 WOODLANDS BLVD STE 220
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2801
Practice Address - Country:US
Practice Address - Phone:303-328-3979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO79331223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics