Provider Demographics
NPI:1366599516
Name:BROCK, AMY ELIZABETH (DMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:ELIZABETH
Last Name:BROCK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 CUMBERLAND FALLS HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2713
Mailing Address - Country:US
Mailing Address - Phone:606-523-0307
Mailing Address - Fax:606-523-9827
Practice Address - Street 1:1040 CUMBERLAND FALLS HWY
Practice Address - Street 2:SUITE A
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2713
Practice Address - Country:US
Practice Address - Phone:606-523-0307
Practice Address - Fax:606-523-9827
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY80981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice