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General NPI Number Information
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NPI Number | 1043681950
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Entity Type | Organization
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Legal Business Name | BROCK ARMS DDS PC
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Dates
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Enumeration Date | 10/19/2015
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 300 PALUSTER ST
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City | CADILLAC
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State | MI
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Zip | 49601-2552
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Country | US
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Telephone | 231-775-8281
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Fax |
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Provider Business Mailing Address
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Address Line | 300 PALUSTER ST
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City | CADILLAC
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State | MI
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Zip | 49601-2552
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BROCK ARMS
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Credential |
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Telephone | 231-775-8281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 16614
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License Number State | MI
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