MEDICARE: DR. EMMA HENRY BROCKMAN

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	30.027629	OH

General Provider Information

NPI Number	:	1720822828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMMA HENRY BROCKMAN

Provider Business Mailing Address
First Line	:	724 HUNTERSKNOLL LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-4353
Country	:	US
Telephone Number	:	304-546-1086
Fax Number	:

Provider Business Practice Location Address
First Line	:	880 EASTGATE NORTH DR STE 101
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245-2051
Country	:	US
Telephone Number	:	513-978-5859
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	06/24/2024

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Directions to “ DR. EMMA HENRY BROCKMAN ” Practice Location

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