Brockton Dental X-Ray Lab., Inc.

Primary specialty

Dental LaboratoryTaxonomy code 292200000X

License

RHP00050468 Issued in CA

Legal business name

BROCKTON DENTAL X-RAY LAB., INC.

Practice address

6800 Brockton Ave Ste 3
Riverside, CA 92506-3810

Phone

(951) 682-7505

Fax

(951) 682-7549

NPI assigned

Sep 15, 2011

Organization subpart

No

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

Authorized official

Name

Michael W. Carpenter

Title

Owner

Phone

(951) 682-7505

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1316044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316044800000",
    "number": "1467734491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 BROCKTON AVE STE 3",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063810",
            "telephone_number": "951-682-7505",
            "fax_number": "951-682-7549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6800 BROCKTON AVE STE 3",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063810",
            "telephone_number": "951-682-7505",
            "fax_number": "951-682-7549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROCKTON DENTAL X-RAY LAB., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-15",
        "last_updated": "2011-09-15",
        "status": "A",
        "authorized_official_last_name": "CARPENTER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-682-7505"
    },
    "taxonomies": [
        {
            "code": "292200000X",
            "taxonomy_group": "",
            "desc": "Dental Laboratory",
            "state": "CA",
            "license": "RHP00050468",
            "primary": true
        },
        {
            "code": "292200000X",
            "taxonomy_group": "",
            "desc": "Dental Laboratory",
            "state": "CA",
            "license": "RHP7971",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Frances Adele Brobst, BHS II
• Mireya Elizabeth Brocatto-Keck, LMFT
• Ronny Angeline Brock
• Brendon Douglas Brockmann, MD
• Lynne M Brockmeier
• Brockton Endoscopy Surgery Center LP
• Brockton Investments & Associates, LLC (Riverside Center for Behavioral Medicine)
• Brockton Surgical Center
• Divine Grace Fernandez Broich
• Aijalon Benet Brooks

• Dental Laboratory in Riverside, CA
• Providers in Riverside, CA by specialty
• Dental Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2011; 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.