Provider Demographics
NPI:1881756278
Name:BROCK, DAVID PHILLIP (DMD MS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PHILLIP
Last Name:BROCK
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 DORMODY CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2908
Mailing Address - Country:US
Mailing Address - Phone:831-373-3703
Mailing Address - Fax:831-324-4075
Practice Address - Street 1:40 DORMODY CT
Practice Address - Street 2:SUITE A
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2908
Practice Address - Country:US
Practice Address - Phone:831-373-3703
Practice Address - Fax:831-324-4075
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA497281223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics