Provider Demographics
NPI:1295706026
Name:BROCKMAN, KURT JEFFREY (DDS)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:JEFFREY
Last Name:BROCKMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 CATHERINE DR
Mailing Address - Street 2:PO BOX 3914
Mailing Address - City:INCLINE VILLAGE
Mailing Address - State:NV
Mailing Address - Zip Code:89450-3914
Mailing Address - Country:US
Mailing Address - Phone:858-922-7928
Mailing Address - Fax:
Practice Address - Street 1:6395 S MCCARRAN BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:775-823-9419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0361371223G0001X
NV67001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice