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General NPI Number Information
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NPI Number | 1720509482
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Entity Type | Organization
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Legal Business Name | JASON R. BROCK DDS, PLLC
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Dates
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Enumeration Date | 07/03/2017
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Last Update Date | 07/03/2017
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Provider Practice Location Address
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Address Line | 17150 EL CAMINO REAL
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City | HOUSTON
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State | TX
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Zip | 77058-2738
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Country | US
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Telephone | 281-461-7470
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Fax |
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Provider Business Mailing Address
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Address Line | 818A YALE ST
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City | HOUSTON
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State | TX
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Zip | 77007-1538
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Country | US
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Telephone | 323-273-9549
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON BROCK
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Credential | DDS
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Telephone | 281-461-7470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 28465
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License Number State | TX
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