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General NPI Number Information
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NPI Number | 1558723213
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Entity Type | Individual
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Provider Name | BROCH THOMAS D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 01/03/2019
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Provider Practice Location Address
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Address Line | 1920 S STAPLEY DR STE 105
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City | MESA
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State | AZ
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Zip | 85204-6678
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Country | US
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Telephone | 480-545-5300
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Fax | 480-545-5303
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Provider Business Mailing Address
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Address Line | 3021 N 39TH ST APT 2
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City | PHOENIX
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State | AZ
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Zip | 85018-7123
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Country | US
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Telephone | 618-339-0800
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 22159
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License Number State | FL
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