MEDICARE: DR. GEORGE S 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
1	1223G0001X	General Practice Dentistry	DN12130	FL

General Provider Information

NPI Number	:	1982603676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE S BROCKMAN DDS

Provider Business Mailing Address
First Line	:	6933 W COMMERCIAL BLVD
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-2119
Country	:	US
Telephone Number	:	954-724-8486
Fax Number	:	954-724-8415

Provider Business Practice Location Address
First Line	:	6933 W COMMERCIAL BLVD
Second Line	:	SUITE A
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-2119
Country	:	US
Telephone Number	:	954-724-8486
Fax Number	:	954-724-8415

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	07/08/2007

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