Matthew Reed Brokaw, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401008695 Issued in VA

Practice address

4924 Dominion Blvd
Suite B
Glen Allen, VA 23060-6766

Phone

(804) 270-6200

Fax

(804) 965-0581

NPI assigned

Sep 26, 2006

Last updated

Nov 10, 2014By the provider in NPPES

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Matthew R. Brokaw, D.D.S., P.C.

  • Dental Clinic/Center
  • Glen Allen, VA
  • NPI 1326230772
  NPD (past) Authorized official

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415577600000",
    "number": "1982705109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4924 DOMINION BLVD",
            "address_2": "SUITE B",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230606766",
            "telephone_number": "804-270-6200",
            "fax_number": "804-965-0581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4924 DOMINION BLVD",
            "address_2": "SUITE B",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230606766",
            "telephone_number": "804-270-6200",
            "fax_number": "804-965-0581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROKAW",
        "first_name": "MATTHEW",
        "middle_name": "REED",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2014-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401008695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "205329",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "979564",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Leigh Bridges
• Bright Integrative Care
• Andrea Lankenau Bright, LCSW
• Andrea Brinkley, MED, EDS
• Kennedy Grace Brogan I
• Broken Chain Foundation
• Brookfield, Inc
• Brookfield, Inc.
• Bryan M. Brooks, M.D.
• Maya Nadeira Brooks, MA

• General Practice Dentistry in Glen Allen, VA
• Providers in Glen Allen, 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 Nov 10, 2014; 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.