Jefferson C. Brock

General Practice Dentistry · Skokie, IL

Individual Active NPI

NPI number 1407974215

Practice location

9631 Gross Point Rd Ste 1
Skokie, IL 60076-1264
Phone
(847) 673-6616

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NPI record

NPI
1407974215
Entity type
Individual (Type 1)
Enumeration date
March 27, 2007
Last updated
July 8, 2007
Sole proprietor
Yes

Specialties & taxonomy codes

TaxonomyCodeLicenseState
General Practice Dentistry Primary 1223G0001X A12889 IL

About Jefferson Brock

Jefferson C. Brock is a healthcare provider registered in the NPI registry with the primary taxonomy General Practice Dentistry (code 1223G0001X). The practice location is 9631 Gross Point Rd Ste 1, Skokie, IL 60076-1264. The NPI number 1407974215 was assigned on March 27, 2007 and the record was last updated on July 8, 2007.

Jefferson Brock lists a license in the registry: #A12889 (IL) for General Practice Dentistry. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Jefferson C. Brock?

The NPI number is 1407974215.

What is the phone number of Jefferson Brock?

The phone number listed for the practice location is (847) 673-6616.

Where is Jefferson Brock located?

9631 Gross Point Rd Ste 1, Skokie, IL 60076-1264.

What is the taxonomy code for Jefferson Brock?

The primary taxonomy code is 1223G0001X – General Practice Dentistry.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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