Healthcare Provider Details

I. General information

NPI: 1982086807
Provider Name (Legal Business Name): DAVID BROCKBANK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2015
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 MDG, UNIT 3215, RAMSTEIN AB
APO AE
09094
US

IV. Provider business mailing address

18 MDG, UNIT 5142
APO AP
96368
US

V. Phone/Fax

Practice location:
  • Phone: 413-479-2113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30959
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30959
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30959
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: