BROCK RADICH (NPI# 1073937223) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073937223 |
| Entity Type | Individual |
| Full Name | BROCK RADICH |
| Credential | DDS |
| Practice Address |
7400 Fleur Dr Ste 200 Des Moines IA 50321-3105 |
| Practice Telephone | 5152877773 |
| Mailing Telephone | 5152877773 |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2020-05-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DDS-09722 | IA | Dental Providers |
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DDS09722 | IA | Dental Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 10521 N Port Washington Rd Ste 150, Mequon, WI 530925561 | 2622410932 | 2622411368 |
| 110 S Wisconsin St Ste 5, Port Washington, WI 530742248 | 2622687821 | 2622687823 |
| 200 W Silver Spring Dr Ste 285, Glendale, WI 532175058 | 4147649105 | |
| N96w18221 County Line Rd, Menomonee Falls, WI 530511361 | 2622511992 | 2622512856 |
| Street Address |
7400 FLEUR DR STE 200 |
| City | DES MOINES |
| State | IA |
| Zip Code | 50321-3105 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386087658 | Michael Morio | Dentist | 7400 Fleur Dr Ste 200, Des Moines, IA 50321-3105 | 2013-04-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518478916 | Anna Marie Bergida | Counselor | 5875 Fleur Dr, Des Moines, IA 50321 | 2017-10-12 |
| 1780842864 | Allison Christine Carlson | Chiropractor | 4600 Park Ave, Des Moines, IA 50321-1237 | 2008-05-27 |
| 1588961668 | Carlson Chiropractic Pllc | Chiropractor | 4600 Park Ave, Des Moines, IA 50321-1237 | 2011-02-25 |
| 1164646691 | Sara Esther Sutton | Family Medicine | 3219 Sw 39th St, Des Moines, IA 50321-1304 | 2007-04-13 |
| 1750696852 | Community Neurorehab of Iowa | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3000 Sw 37th St, Des Moines, IA 50321-1330 | 2010-08-12 |
| 1942714514 | Donald Joseph Anderson | Surgery | 3317 Southern Hills Dr, Des Moines, IA 50321-1434 | 2017-11-19 |
| 1235461286 | Thomas Patrick Reynolds | Counselor | 3615 Thornton Ave, Des Moines, IA 50321-1845 | 2010-02-02 |
| 1023210671 | Marwin E. Goff | Dentist | 3906 Wolcott Ave, Des Moines, IA 50321-1868 | 2007-06-05 |
| 1285986711 | Jordan Samuelson | Counselor | 4100 Wolcott Ave, Des Moines, IA 50321-1872 | 2012-10-08 |
| 1134426331 | Harbor View Medical | Physical Medicine & Rehabilitation | 6151 Thornton Ave., Suite 200, Des Moines, IA 50321-1900 | 2011-02-24 |
| Find all providers in zip 50321 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386087658 | Michael Morio | Dentist | 7400 Fleur Dr Ste 200, Des Moines, IA 50321-3105 | 2013-04-16 |
| 1801093067 | Ryan A Marsh | Dentist | 7400 Fleur Dr, Ste 200, Des Moines, IA 50321-3105 | 2007-06-29 |
| 1386847630 | John D. Janulewicz | Dentist | 7400 Fleur Drive, Suite 200, Des Moines, IA 50321-3104 | 2007-06-06 |
| 1659342848 | Marvin C Jepsen | Dentist | 3940 Ingersoll Ave, Des Moines, IA 50312-3506 | 2006-01-27 |
| 1083860985 | Luke James Freml | Dentist | 7400 Fleur Dr, Des Moines, IA 50321-3105 | 2008-08-11 |
| 1548231434 | Scott A Johnson | Dentist | 3940 Ingersoll Ave, Des Moines, IA 50312-3506 | 2006-01-30 |
| 1760453757 | Dennis J Lowman | Dentist | 3940 Ingersoll Ave, Des Moines, IA 50312-3506 | 2006-01-30 |
| 1669443651 | Jeffery A Schwarzkopf | Dentist | 3940 Ingersoll Ave, Des Moines, IA 50312-3506 | 2006-01-30 |
| 1558332445 | John A Frank | Dentist | 3940 Ingersoll Ave, Des Moines, IA 50312-3506 | 2006-01-30 |
| 1275504177 | Oral Surgeons, P.C. | Dentist | 3940 Ingersoll Ave, Des Moines, IA 50312-3506 | 2006-01-30 |
| Find all providers in DES MOINES | ||||
| City | DES MOINES |
| Zip Code | 50321 |
Please comment or provide details below to improve the information on BROCK RADICH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.