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NPI Code Detail

MEDICARE: DR. LARRY RICHARD BROCK D.M.D.

MEDICARE:  DR. LARRY RICHARD BROCK  D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry23795TX
21223G0001XGeneral Practice DentistryDS018023LPA

General Provider Information

NPI Number : 1376646448
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LARRY RICHARD BROCK D.M.D.
Provider Business Mailing Address
First Line : 4410 WESTHEIMER RD
Second Line : APT. 2402
City : HOUSTON
State : TX
Zip : 77027-4812
Country : US
Telephone Number : 724-513-2416
Fax Number :
Provider Business Practice Location Address
First Line : 1454 CAMPBELL RD
Second Line : SUITE 200
City : HOUSTON
State : TX
Zip : 77055-4604
Country : US
Telephone Number : 724-513-2416
Fax Number : 281-265-1850
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2006
Last Update Date : 04/11/2014

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Directions to “ DR. LARRY RICHARD BROCK D.M.D.” Practice Location

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