Provider Demographics
NPI:1982603676
Name:BROCKMAN, GEORGE S (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:S
Last Name:BROCKMAN
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 1:6933 W COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2119
Mailing Address - Country:US
Mailing Address - Phone:954-724-8486
Mailing Address - Fax:954-724-8415
Practice Address - Street 1:6933 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-2119
Practice Address - Country:US
Practice Address - Phone:954-724-8486
Practice Address - Fax:954-724-8415
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN121301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice