Individual
DR. MATTHEW REED BROKAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4924 DOMINION BLVD, SUITE B, GLEN ALLEN, VA 23060-6766
(804) 270-6200
(804) 965-0581
Mailing address
4924 DOMINION BLVD, SUITE B, GLEN ALLEN, VA 23060-6766
(804) 270-6200
(804) 965-0581
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401008695
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
205329
ANTHEM BCBS
VA
01
—
979564
UNITED CONCORDIA
VA
Enumeration date
09/26/2006
Last updated
11/10/2014
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