Provider Demographics
NPI:1306188156
Name:PUMPHREY, BROCK J I (DMD)
Entity type:Individual
Prefix:DR
First Name:BROCK
Middle Name:J
Last Name:PUMPHREY
Suffix:I
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 PEACHTREE ST NE STE 710
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3964
Mailing Address - Country:US
Mailing Address - Phone:404-876-4867
Mailing Address - Fax:
Practice Address - Street 1:999 PEACHTREE ST NE STE 710
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3964
Practice Address - Country:US
Practice Address - Phone:404-876-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0145821223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics