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General NPI Number Information
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NPI Number | 1205164704
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Entity Type | Individual
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Provider Name | BROCK AARON DROLL DMD, MS
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Gender | Male
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Dates
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Enumeration Date | 11/23/2009
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 1900 KRUCHTEN CT S STE 100
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City | SARTELL
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State | MN
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Zip | 56377-2701
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Country | US
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Telephone | 320-656-1456
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 KRUCHTEN CT S STE 100
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City | SARTELL
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State | MN
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Zip | 56377-2701
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Country | US
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Telephone | 320-656-1456
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 30.023036
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | D13005
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License Number State | MN
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