Wells S. Brockbank, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

142412 Issued in UT

Practice address

490 N Main St
Spanish Fork, UT 84660-1440

Phone

(801) 798-9874

Fax

(801) 798-9630

NPI assigned

Sep 20, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487752630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "490 N MAIN ST",
            "city": "SPANISH FORK",
            "state": "UT",
            "postal_code": "846601440",
            "telephone_number": "801-798-9874",
            "fax_number": "801-798-9630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 N MAIN ST",
            "city": "SPANISH FORK",
            "state": "UT",
            "postal_code": "846601440",
            "telephone_number": "801-798-9874",
            "fax_number": "801-798-9630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCKBANK",
        "first_name": "WELLS",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "142412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ricky Travis Brandon
• Michael Brannin
• Shaun Scott Briggs, D.D.S
• Paul Kenneth Brimley
• Bryce Brindley, DC
• Andrew Brown, MFTI
• Jacob Brown
• Jayci Brown, APRN
• Mackenzie Brown, OTR
• Michael Brown, BCBA

• General Practice Dentistry in Spanish Fork, UT
• Providers in Spanish Fork, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.