Individual
MIKAELA AN BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
150 S HUNTINGTON AVE, BOSTON, MA 02130-4817
(617) 232-9500
Mailing address
15 VERNON ST APT 3, BROOKLINE, MA 02446-4952
(256) 804-8217
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN1859756
MA
Other
Enumeration date
04/18/2023
Last updated
02/05/2024
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