Individual
DR. JEFFERSON C BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9631 GROSS POINT RD STE 1, SKOKIE, IL 60076-1264
(847) 673-6616
Mailing address
9631 GROSS POINT RD STE 1, SKOKIE, IL 60076-1264
(847) 673-6616
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
A12889
IL
Other
Enumeration date
03/27/2007
Last updated
07/08/2007
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