Active NPI
Douglas John Brockman, DDS
- Pediatric Dentistry
- Middletown, OH
National Provider Identifier
1174583306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 18488
- Practice address
- 210 S Breiel Blvd
Middletown, OH 45044-5157 - Phone
- (513) 423-9239
- NPI assigned
- Mar 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 18488 | OH | Primary |
Addresses
Primary practice location
210 S Breiel Blvd
Middletown, OH 45044-5157
Mailing address
210 S Breiel Blvd
Middletown, OH 45044-5157
Phone (513) 423-9239
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0701379 | Medicaid | OH | |
| 0743637 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18488 | OH | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416787200000",
"number": "1174583306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 S BREIEL BLVD",
"city": "MIDDLETOWN",
"state": "OH",
"postal_code": "450445157",
"telephone_number": "513-423-9239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 S BREIEL BLVD",
"city": "MIDDLETOWN",
"state": "OH",
"postal_code": "450445157",
"telephone_number": "513-423-9239"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCKMAN",
"first_name": "DOUGLAS",
"middle_name": "JOHN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-23",
"last_updated": "2014-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "OH",
"license": "18488",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0701379",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0743637",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Middletown, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.