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General NPI Number Information
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NPI Number | 1841033867
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Entity Type | Individual
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Provider Name | DANIEL JOSEPH BROCK DDS
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Gender | Male
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Dates
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Enumeration Date | 06/17/2024
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 2170 POSTLE HALL 305 W. 12TH AVENUE
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City | COLUMBUS
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State | OH
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Zip | 43210
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Country | US
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Telephone | 614-247-1735
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Fax |
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Provider Business Mailing Address
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Address Line | 2344 N MERRIT CRK LOOP
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4950
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Country | US
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Telephone | 702-588-8327
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4771458
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.027616
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License Number State | OH
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