MEDICARE: BROCKMAN BEECHMONT MODERN DENTISTRY PC, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1033046115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROCKMAN BEECHMONT MODERN DENTISTRY PC, INC

Provider Business Mailing Address
First Line	:	PO BOX 660041
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75266-0041
Country	:	US
Telephone Number	:	714-845-8890
Fax Number	:	303-952-0892

Provider Business Practice Location Address
First Line	:	7860 BEECHMONT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45255-4213
Country	:	US
Telephone Number	:	513-993-0922
Fax Number	:	513-514-8437

Authorized Official
Title or Position	:	OWNER
Name	:	EMMA H BROCKMAN
Credential	:	DDS
Telephone Number	:	513-993-0922

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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