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General NPI Number Information
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NPI Number | 1457416299
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Entity Type | Individual
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Provider Name | BRIAN J BLOCHER DDS
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Gender | Male
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 201 N MAYFAIR RD SUITE 520
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City | WAUWATOSA
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State | WI
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Zip | 53226
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Country | US
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Telephone | 414-607-0222
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Fax | 414-607-0220
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Provider Business Mailing Address
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Address Line | 201 N MAYFAIR RD SUITE 520
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City | WAUWATOSA
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State | WI
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Zip | 53226
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Country | US
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Telephone | 414-607-0222
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Fax | 414-607-0220
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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 | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 4002
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License Number State | WI
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