Individual
JOHN E BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
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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