Individual
JOHN E BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
100A PRESTIGE PARK DR, HURRICANE, WV 25526-8417
(304) 757-0272
(304) 757-0273
Mailing address
103 STATION PLACE WAY, HURRICANE, WV 25526-8747
(304) 720-7819
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
3308
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10439
KY DENTAL LICENSE
KY
01
—
129
SPECIALIST, ORAL AND MAXILLOFACIAL SURGERY
WV
01
—
3308
WV DENTAL LIC.
WV
05
—
3810012787
—
WV
Enumeration date
08/12/2006
Last updated
09/26/2022
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