Healthcare Provider Details

I. General information

NPI: 1609911965
Provider Name (Legal Business Name): LAWRENCE ARTHUR BROCKMAN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9025 WILSHIRE BLVD SUITE 307
BEVERLY HILLS CA
90211-1831
US

IV. Provider business mailing address

9025 WILSHIRE BLVD SUITE 307
BEVERLY HILLS CA
90211-1831
US

V. Phone/Fax

Practice location:
  • Phone: 310-274-0070
  • Fax: 310-274-9027
Mailing address:
  • Phone: 310-274-0070
  • Fax: 310-274-9027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number22948
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: