Provider Demographics
NPI:1457368151
Name:RALPH A BROCK II DDS, MS, PA
Entity Type:Organization
Organization Name:RALPH A BROCK II DDS, MS, PA
Other - Org Name:BROCK ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:281-829-9000
Mailing Address - Street 1:22167 WESTHEIMER PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-8300
Mailing Address - Country:US
Mailing Address - Phone:281-829-9000
Mailing Address - Fax:281-829-9155
Practice Address - Street 1:22167 WESTHEIMER PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-8300
Practice Address - Country:US
Practice Address - Phone:281-829-9000
Practice Address - Fax:281-829-9155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204451223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty