# ANTHONY R BROCK DMD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Stetson Village Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790239010
- **Authorized official:** DR. ANTHONY R BROCK DMD (MANAGER)
- **Authorized official phone:** (623) 533-4895

## Contact information

- **Practice address:** 3870 W HAPPY VALLEY RD, SUITE \#154, GLENDALE, AZ 85310-3295
- **Practice address phone:** (623) 533-4895
- **Practice address fax:** (623) 533-6246
- **Mailing address:** 3870 W HAPPY VALLEY RD, SUITE \#154, GLENDALE, AZ 85310-3295
- **Mailing address phone:** (623) 533-4895
- **Mailing address fax:** (623) 533-6246

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 8885 | AZ | Yes |

## Other

- **Enumeration date:** 08/04/2016
- **Last updated:** 08/04/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1083976732 | NPI\# | AZ |