Individual
DR. JEREMY DUSTIN BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
10868 US HIGHWAY 15 501, SOUTHERN PINES, NC 28387-5149
(910) 585-0262
Mailing address
10868 US 15 501 HWY, SOUTHERN PINES, NC 28387-5149
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
12842
NC
1223G0001X
General Practice Dentistry
Primary
12842
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/15/2022
Last updated
05/25/2023
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