Tyler Brockman, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10945 Issued in KY

Practice address

225 Crescent Hill PL Apt 209
Louisville, KY 40206-2480

Phone

(502) 377-4362

NPI assigned

Jun 12, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1686528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686528000000",
    "number": "1548944465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 CRESCENT HILL PL APT 209",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402062480",
            "telephone_number": "502-377-4362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 CRESCENT HILL PL APT 209",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402062480",
            "telephone_number": "502-377-4362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCKMAN",
        "first_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-12",
        "last_updated": "2023-06-12",
        "certification_date": "2023-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12014121A",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "10945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neteka Lasha Brock
• Sarah Brock, LCADC
• Kathy Brockman
• Mark A Brockman, MD
• Michael Brockman, DNP
• Rebecca Brodbeck
• Allison Kay Broderick, APRN, FNP-C
• Carla Marie Broderick, APRN
• Susan S Broderick
• Samantha Brodsky, RPH

• General Practice Dentistry in Louisville, KY
• Providers in Louisville, KY by specialty
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 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.

Verify at the official NPI Registry.