Brokaw, Matthew Reed

Brokaw, Matthew Reed is an individual health care provider with primary practice located at 4924 Dominion Blvd Suite B, Glen Allen VA 23060-6766. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Brokaw, Matthew Reed can be contacted via phone (804) 270-6200.

Contact Information

Primary practice address
4924 Dominion Blvd Suite B Glen Allen VA 23060-6766
Phone: (804) 270-6200
Fax: (804) 965-0581
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 0401008695 Virginia

Profile Details

NPI number 1982705109
LBN Legal business name Brokaw, Matthew Reed
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 26th, 2006
Last updated Nov 10th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982705109 NPPES
Virginia Other 979564 UNITED CONCORDIA
Virginia Other 205329 UNITED CONCORDIA

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