Healthcare Provider Details

I. General information

NPI: 1376432484
Provider Name (Legal Business Name): DAVID L BROCKMAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5945 S 56TH ST STE 100
LINCOLN NE
68516-3394
US

IV. Provider business mailing address

5945 S 56TH ST STE 100
LINCOLN NE
68516-3394
US

V. Phone/Fax

Practice location:
  • Phone: 402-420-2400
  • Fax: 402-420-2418
Mailing address:
  • Phone: 402-420-2400
  • Fax: 402-420-2418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MANDY E SMITH
Title or Position: OFFICE MANAGER
Credential:
Phone: 402-420-2400