Individual provider Active NPI

Lawrence Arthur Brockman, D.M.D.

  • Endodontics
  • Beverly Hills, CA
National Provider Identifier
1609911965
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
22948 Issued in CA
Practice address
9025 Wilshire Blvd
Suite 307
Beverly Hills, CA 90211-1831
Phone
(310) 274-0070
Fax
(310) 274-9027
NPI assigned
Feb 21, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X 22948 CA Primary

Addresses

Primary practice location

9025 Wilshire Blvd
Suite 307
Beverly Hills, CA 90211-1831

Mailing address

9025 Wilshire Blvd
Suite 307
Beverly Hills, CA 90211-1831
Phone (310) 274-0070

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20160205000548 CA Order and Referring Only - DentistPractitioner - Dentist 8022312453

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22948CAMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609911965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9025 WILSHIRE BLVD",
            "address_2": "SUITE 307",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902111831",
            "telephone_number": "310-274-0070",
            "fax_number": "310-274-9027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9025 WILSHIRE BLVD",
            "address_2": "SUITE 307",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902111831",
            "telephone_number": "310-274-0070",
            "fax_number": "310-274-9027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCKMAN",
        "first_name": "LAWRENCE",
        "middle_name": "ARTHUR",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "22948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly Hills, CA

Sources for this page

Verify at the official NPI Registry.