Active NPI
Adam Wiley Brock, DMD
- Periodontics
- Fort Gregg Adams, VA
National Provider Identifier
1184930653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DS0382820
- Practice address
- 700 24TH St
Fort Gregg Adams, VA 23801-1716 - Phone
- (804) 734-9607
- NPI assigned
- Aug 23, 2010
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DS0382820 | PA | Primary |
Addresses
Primary practice location
700 24TH St
Fort Gregg Adams, VA 23801-1716
Mailing address
228 Beeman PL
Ft Riley, KS 66442-7009
Phone (785) 239-4261
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 |
|---|---|---|---|
| DS0382820 | PA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684886400000",
"number": "1184930653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "228 BEEMAN PL",
"city": "FT RILEY",
"state": "KS",
"postal_code": "664427009",
"telephone_number": "785-239-4261"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 24TH ST",
"city": "FORT GREGG ADAMS",
"state": "VA",
"postal_code": "238011716",
"telephone_number": "804-734-9607"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCK",
"first_name": "ADAM",
"middle_name": "WILEY",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-08-23",
"last_updated": "2023-05-24",
"certification_date": "2023-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "PA",
"license": "DS0382820",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Gregg Adams, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.