Blake Douglass Brockbank, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401418996 Issued in VA

Practice address

407 Starling Ave
Martinsville, VA 24112-3731

Phone

(276) 632-9266

NPI assigned

Jun 11, 2024

Sex

Male

Sole proprietor

No

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

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": "1718064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718064000000",
    "number": "1871335703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 CORN TASSEL TRL",
            "city": "MARTINSVILLE",
            "state": "VA",
            "postal_code": "241125607",
            "telephone_number": "801-598-8837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 STARLING AVE",
            "city": "MARTINSVILLE",
            "state": "VA",
            "postal_code": "241123731",
            "telephone_number": "276-632-9266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCKBANK",
        "first_name": "BLAKE",
        "middle_name": "DOUGLASS",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-11",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401418996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridge of Faith, LLC
• Henry E. Bridges Jr., MD
• Jeffery Brister, PHARMD
• Brnursco LLC
• Broc LLC
• Lori A Brodie, LPC
• Derek Brown, MSW, LMHP-S
• Sherery Roshelle Brown
• Cameron Glenn Brummitt, DPT
• Linda Buchanan, MD

• General Practice Dentistry in Martinsville, VA
• Providers in Martinsville, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2024; 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.