Individual
BLAKE DOUGLASS BROCKBANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
407 STARLING AVE, MARTINSVILLE, VA 24112-3731
(276) 632-9266
Mailing address
1107 CORN TASSEL TRL, MARTINSVILLE, VA 24112-5607
(801) 598-8837
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401418996
VA
Other
Enumeration date
06/11/2024
Last updated
06/11/2024
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