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General NPI Number Information
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NPI Number | 1699541813
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Entity Type | Organization
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Legal Business Name | JACOB BROTZMAN DMD PLLC
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Dates
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Enumeration Date | 11/29/2023
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 4721 COUNTRY CLUB RD
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City | WINSTON SALEM
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State | NC
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Zip | 27104-3521
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Country | US
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Telephone | 919-961-8552
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Fax |
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Provider Business Mailing Address
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Address Line | 14 E DEVONSHIRE ST
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City | WINSTON SALEM
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State | NC
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Zip | 27127-3033
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Country | US
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Telephone | 919-961-8552
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | JACOB BROTZMAN
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Credential | DMD
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Telephone | 919-961-8552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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