Provider Demographics
NPI:1932129467
Name:LIVICK, BROCKTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:BROCKTON
Middle Name:
Last Name:LIVICK
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 1:5318 PATTERSON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2044
Mailing Address - Country:US
Mailing Address - Phone:804-282-9600
Mailing Address - Fax:
Practice Address - Street 1:5318 PATTERSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2044
Practice Address - Country:US
Practice Address - Phone:804-282-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA53741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice