Individual
ROBERT L BROCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
6129 W CORPORATE OAKS DR, CRYSTAL RIVER, FL 34429-8732
(352) 795-4994
(352) 795-4609
Mailing address
6129 W CORPORATE OAKS DR, CRYSTAL RIVER, FL 34429-8732
(352) 795-4994
(352) 795-4609
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN 8810
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
073131500
—
FL
Enumeration date
09/21/2006
Last updated
07/08/2007
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