Individual
BRIAN J BLOCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
201 N MAYFAIR RD, SUITE 520, WAUWATOSA, WI 53226
(414) 607-0222
(414) 607-0220
Mailing address
201 N MAYFAIR RD, SUITE 520, WAUWATOSA, WI 53226
(414) 607-0222
(414) 607-0220
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
4002
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33683900
—
WI
Enumeration date
12/22/2006
Last updated
05/30/2013
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