David E. Brockett D.D.S. Inc.

Primary specialty

DentistTaxonomy code 122300000X

License

25483 Issued in CA

Legal business name

DAVID E. BROCKETT D.D.S. INC.

Practice address

7804 Ivanhoe Ave.
La Jolla, CA 92037

Phone

(858) 454-1468

Fax

(858) 454-1696

NPI assigned

Jul 12, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David Eastman Brockett, DDS.

Title

President

Phone

(858) 454-1468

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1278892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278892800000",
    "number": "1114239738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7804 IVANHOE AVE.",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "92037",
            "telephone_number": "858-454-1468",
            "fax_number": "858-454-1696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7804 IVANHOE AVE.",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "92037",
            "telephone_number": "858-454-1468",
            "fax_number": "858-454-1696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID E. BROCKETT D.D.S. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-12",
        "last_updated": "2010-07-12",
        "status": "A",
        "authorized_official_last_name": "BROCKETT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "EASTMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-454-1468",
        "authorized_official_credential": "DDS."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "25483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.