Jimmy L. Brock, D.M.D.
Individual provider Active NPI Dentist · Bowdon, GA
NPI 1497925903 · NPPES record last updated Mar 11, 2008
Key facts
- NPI
- 1497925903
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 8166 (GA)
- Practice address
- 429 Mitchell Ave
Bowdon, GA 30108-1405 - Phone
- (770) 258-5516
- Fax
- (770) 258-5517
- NPI assigned
- Mar 11, 2008
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8166 | GA | Yes |
Addresses
Primary practice location
429 Mitchell Ave
Bowdon, GA 30108-1405
Mailing address
429 Mitchell Ave
Bowdon, GA 30108-1405
Phone (770) 258-5516
Other providers in Bowdon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 11, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.