Provider Demographics
NPI:1720251424
Name:BROWN, BROCK WARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:BROCK
Middle Name:WARD
Last Name:BROWN
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 1:11715 RAINWOOD RD STE A2
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-3967
Mailing Address - Country:US
Mailing Address - Phone:501-225-9067
Mailing Address - Fax:501-225-9081
Practice Address - Street 1:11715 RAINWOOD RD STE A2
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-3967
Practice Address - Country:US
Practice Address - Phone:501-225-9067
Practice Address - Fax:501-225-9081
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist