Provider Demographics
NPI:1154583771
Name:DAVID F BROCKMAN
Entity type:Organization
Organization Name:DAVID F BROCKMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:BROCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-753-7366
Mailing Address - Street 1:2524 CRESTWOOD RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7623
Mailing Address - Country:US
Mailing Address - Phone:501-753-7366
Mailing Address - Fax:
Practice Address - Street 1:2524 CRESTWOOD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7623
Practice Address - Country:US
Practice Address - Phone:501-753-7366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2516122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty