| Matthew R. Brokaw, D.d.s., P.c. | |
|
4924 Dominion Blvd Suite B Glen Allen VA 23060-6766 | |
| (804) 270-6200 | |
| (804) 965-0581 |
| Full Name | Matthew R. Brokaw, D.d.s., P.c. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4924 Dominion Blvd, Glen Allen, Virginia |
| Authorized Official Name and Position | Matthew Reed Brokaw (PRESIDENT/SECRETARY/OWNER) |
| Authorized Official Contact | 8042706200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Matthew R. Brokaw, D.d.s., P.c. 4924 Dominion Blvd Suite B Glen Allen VA 23060-6766 Ph: (804) 270-6200 | Matthew R. Brokaw, D.d.s., P.c. 4924 Dominion Blvd Suite B Glen Allen VA 23060-6766 Ph: (804) 270-6200 |
| NPI Number | 1326230772 |
|---|---|
| Provider Enumeration Date | 08/09/2007 |
| Last Update Date | 11/04/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326230772 | NPI | - | NPPES |
| 205329 | Other | VA | ANTHEM BCBS |
| 979564 | Other | VA | UNITED CONCORDIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 0401008695 (Virginia) | Primary |
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