Provider Demographics
NPI:1609911965
Name:BROCKMAN, LAWRENCE ARTHUR (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ARTHUR
Last Name:BROCKMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9025 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1831
Mailing Address - Country:US
Mailing Address - Phone:310-274-0070
Mailing Address - Fax:310-274-9027
Practice Address - Street 1:9025 WILSHIRE BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1831
Practice Address - Country:US
Practice Address - Phone:310-274-0070
Practice Address - Fax:310-274-9027
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA229481223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics