Individual
BROCK RADICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DDS-09722
IA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DDS09722
IA
Other
Enumeration date
02/07/2014
Last updated
05/15/2020
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