Provider Demographics
NPI:1477868255
Name:BROCK, ERIN R (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:R
Last Name:BROCK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25977 SW MEADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-8433
Mailing Address - Country:US
Mailing Address - Phone:503-505-3031
Mailing Address - Fax:
Practice Address - Street 1:1251 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1994
Practice Address - Country:US
Practice Address - Phone:503-391-2219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD94931223G0001X
CA611471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice