Healthcare Provider Details

I. General information

NPI: 1841033867
Provider Name (Legal Business Name): DANIEL JOSEPH BROCK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 POSTLE HALL 305 W. 12TH AVENUE
COLUMBUS OH
43210
US

IV. Provider business mailing address

2344 N MERRIT CRK LOOP
COEUR D ALENE ID
83814-4950
US

V. Phone/Fax

Practice location:
  • Phone: 614-247-1735
  • Fax:
Mailing address:
  • Phone: 702-588-8327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.027616
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4771458
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: