Augustus Brock, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

30.026235 Issued in OH

Practice address

3012 Glenmore Ave Ste 206
Cincinnati, OH 45238-2258

Phone

(513) 661-6576

NPI assigned

Jul 2, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Real Dental LLC

  • Dental Clinic/Center
  • Cincinnati, OH
  • NPI 1417487646
  NPD

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

{
    "created_epoch": "1593648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593648000000",
    "number": "1124645494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7832 ZION HILL RD",
            "city": "CLEVES",
            "state": "OH",
            "postal_code": "450029697",
            "telephone_number": "513-607-3422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3012 GLENMORE AVE STE 206",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452382258",
            "telephone_number": "513-661-6576"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7074 Harrison Ave",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452478301",
            "country_code": "US",
            "telephone_number": "513-923-1215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROCK",
        "first_name": "AUGUSTUS",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-02",
        "last_updated": "2020-07-02",
        "certification_date": "2020-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.026235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles Edward Broadnax Jr.
• Christina Broadnax
• Walter G Broadnax, M.D.
• Arthur Thomas Broadstock, MD
• Kassius James Broadus
• Christina Brock, LISW-S
• Jasmine Brock
• Jessica Brock
• Kylie Brock, RDN
• Logan Brock

• Dentist in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2020; 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.