Healthcare Provider Details

I. General information

NPI: 1801902531
Provider Name (Legal Business Name): DAVID FALLS BROCKMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 CIMARRON VALLEY DR
LITTLE ROCK AR
72212-3502
US

IV. Provider business mailing address

62 CIMARRON VALLEY DR
LITTLE ROCK AR
72212-3502
US

V. Phone/Fax

Practice location:
  • Phone: 501-580-6646
  • Fax:
Mailing address:
  • Phone: 501-580-6646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10448
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2516
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: