MEDICARE: DR. BROCK DEAL D.D.S.

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
1	1223E0200X	Endodontics	7933	CO

General Provider Information

NPI Number	:	1467567198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BROCK DEAL D.D.S.

Provider Business Mailing Address
First Line	:	4344 WOODLANDS BLVD STE 220
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-2801
Country	:	US
Telephone Number	:	303-328-3979
Fax Number	:

Provider Business Practice Location Address
First Line	:	4344 WOODLANDS BLVD STE 220
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-2801
Country	:	US
Telephone Number	:	303-328-3979
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	01/28/2022

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