Provider Demographics
NPI:1720822828
Name:BROCKMAN, EMMA HENRY
Entity type:Individual
Prefix:DR
First Name:EMMA
Middle Name:HENRY
Last Name:BROCKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:RYAN
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:724 HUNTERSKNOLL LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4353
Mailing Address - Country:US
Mailing Address - Phone:304-546-1086
Mailing Address - Fax:
Practice Address - Street 1:880 EASTGATE NORTH DR STE 101
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-2051
Practice Address - Country:US
Practice Address - Phone:513-978-5859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0276291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty