Organization
CITRUS ORAL AND MAXILLOFACIAL SURGERY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT L BROCKETT DMD (OWNER/PRESIDENT)
(352) 795-4994
Entity
Organization
Contact information
Practice address
6129 W CORPORATE OAKS DR, CRYSTAL RIVER, FL 34429-8732
(352) 795-4994
Mailing address
6129 W CORPORATE OAKS DR, CRYSTAL RIVER, FL 34429-8732
(352) 795-4994
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
8810
FL
Other
Enumeration date
12/12/2011
Last updated
12/12/2011
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