NPIMap

Organization Active NPI

Matthew R. Brokaw, D.D.S., P.C.

  • Dental Clinic/Center
  • Glen Allen, VA
National Provider Identifier
1326230772
Registry record updated Nov 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
0401008695 Issued in VA
Legal business name
MATTHEW R. BROKAW, D.D.S., P.C.
Practice address
4924 Dominion Blvd
Suite B
Glen Allen, VA 23060-6766
Phone
(804) 270-6200
Fax
(804) 965-0581
NPI assigned
Aug 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2014

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

Authorized official

Name
Dr. Matthew Reed Brokaw, D.D.S.NPI 1982705109
Title
President/Secretary/Owner
Phone
(804) 270-6200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 0401008695 VA Primary

Addresses

Primary practice location

4924 Dominion Blvd
Suite B
Glen Allen, VA 23060-6766

Mailing address

4924 Dominion Blvd
Suite B
Glen Allen, VA 23060-6766
Phone (804) 270-6200

Other identifiers 2

IdentifierTypeStateIssuer
205329OtherVAANTHEM BCBS
979564OtherVAUNITED CONCORDIA

National Provider Directory

National Provider Directory

Locations

4924 Dominion Blvd
#B
Glen Allen, VA 23060
Phone (804) 270-6200

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1186617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415059200000",
    "number": "1326230772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4924 DOMINION BLVD",
            "address_2": "SUITE B",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230606766",
            "telephone_number": "804-270-6200",
            "fax_number": "804-965-0581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4924 DOMINION BLVD",
            "address_2": "SUITE B",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230606766",
            "telephone_number": "804-270-6200",
            "fax_number": "804-965-0581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW R. BROKAW, D.D.S., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-09",
        "last_updated": "2014-11-04",
        "status": "A",
        "authorized_official_last_name": "BROKAW",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "REED",
        "authorized_official_title_or_position": "PRESIDENT/SECRETARY/OWNER",
        "authorized_official_telephone_number": "804-270-6200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "VA",
            "license": "0401008695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "205329",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "979564",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Allen, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 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.

Verify at the official NPI Registry.