Healthcare Provider Details

I. General information

NPI: 1487644944
Provider Name (Legal Business Name): DAVID L BROCKMAN DDS,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

5945 S 56TH ST SUITE 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 Number5766
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: