Basic Information
| Provider Information | |||||||||
| NPI: | 1295706026 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROCKMAN | ||||||||
| FirstName: | KURT | ||||||||
| MiddleName: | JEFFREY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 506 CATHERINE DR | ||||||||
| Address2: | PO BOX 3914 | ||||||||
| City: | INCLINE VILLAGE | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894503914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8589227928 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6395 S MCCARRAN BLVD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758239419 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 08/07/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 036137 | CA | N | Dental Providers | Dentist | General Practice | 1223G0001X | 6700 | NV | Y | Dental Providers | Dentist | General Practice |
No ID Information.