Individual
AUSTIN MICHAEL BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3870 W HAPPY VALLEY RD, GLENDALE, AZ 85310-3295
(623) 533-4895
Mailing address
8478 W MONONA LN, PEORIA, AZ 85382-7418
(360) 477-9288
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D012158
AZ
1223G0001X
General Practice Dentistry
D012158
AZ
Other
Enumeration date
06/03/2024
Last updated
06/27/2024
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