Individual
DR. KENNETH ROBERT BROCKER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3135 W 111TH ST, CHICAGO, IL 60655
(773) 238-4451
(773) 238-9561
Mailing address
3135 W 111TH ST, CHICAGO, IL 60655
(773) 238-4451
(773) 238-9561
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
IL
Other
Enumeration date
05/03/2006
Last updated
07/08/2007
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