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NPI Code Detail

MEDICARE: DR. BRENDA ANN BROCKMAN DDS

MEDICARE: DR. BRENDA ANN BROCKMAN DDS
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 DentistryD10939MN

General Provider Information

NPI Number : 1912066994
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRENDA ANN BROCKMAN DDS
Provider Business Mailing Address
First Line : 3620 SUNRISE DR E
Second Line :
City : MINNETONKA
State : MN
Zip : 55345-2231
Country : US
Telephone Number : 952-945-5147
Fax Number :
Provider Business Practice Location Address
First Line : 6437 BROOKLYN BLVD
Second Line :
City : BROOKLYN CENTER
State : MN
Zip : 55429-2174
Country : US
Telephone Number : 763-531-7177
Fax Number : 763-535-6284
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2006
Last Update Date : 07/08/2007

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Directions to “ DR. BRENDA ANN BROCKMAN DDS” Practice Location

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