Provider Demographics
NPI:1487644944
Name:BROCKMAN, DAVID L (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:BROCKMAN
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5945 S 56TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3394
Mailing Address - Country:US
Mailing Address - Phone:402-420-2400
Mailing Address - Fax:402-420-2418
Practice Address - Street 1:5945 S 56TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-3394
Practice Address - Country:US
Practice Address - Phone:402-420-2400
Practice Address - Fax:402-420-2418
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE57661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE05286OtherBLUE CROSS PROVIDER NUMBE
NE40694OtherDELTA PROVIDER NUMBER