ETHAN LEE BROCKETT


Address: Shaw Afb Dental Clinic, Shaw Afb, AE 29152
Phone: 8038956988

ETHAN LEE BROCKETT (NPI# 1487201695) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1487201695
Entity Type Individual
Full Name ETHAN LEE BROCKETT
Credential DDS
Practice Address Shaw Afb Dental Clinic
Shaw Afb
AE 29152
Mailing Address 273 Knight Valley Cir
Columbia
SC 29209-3166
Practice Telephone 8038956988
Mailing Telephone 9792196946
Enumeration Date 2019-08-22
Last Update Date 2019-08-22
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 1223G0001X Dentist
Specialization: General Practice
109446829921 UT Dental Providers

Office Location

Street Address SHAW AFB DENTAL CLINIC
City SHAW AFB
State AE
Zip Code 29152

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1275066821 Travis B Grindstaff General Acute Care Hospital 411 Polifka Dr, Shaw Afb, SC 29152 2017-04-10
1851791578 Terrance Walker Psychologist 431 Meadow St, Sumter, SC 29152 2014-08-29
1124258967 Jacqueline Mintz Nurse Practitioner 524 Nelson Ave, Shaw Afb, SC 29152 2009-07-14
1396970117 Jennifer N Steele Military Health Care Provider 411 Meadowlark St, Shaw A F B, SC 29152 2009-05-22
1285899146 Elizabeth Ann Vandevelde Nurse Practitioner 129 North Washington, Tuomey Healthcare System, Sumter, SC 29152 2008-07-21
1134211089 Kibrom T Mehari Dentist 449 Shaw Dr, Shaw A F B, SC 29152 2006-09-29
1134155773 Theresa Jean Ulichney Registered Nurse 420 Polifka Dr, Shaw Afb, SC 29152 2006-06-24
1366415184 Kimberly Marie Shanks Nurse Practitioner 431 Meadowlark Rd, Shaw Afb, SC 29152 2006-02-10
1194710780 Anthony Shawn Bankes Family Medicine 411 Medowlark, Shaw Afb, SC 29152 2005-09-20
1861957516 Charles Bradford Davis Physician Assistant 411 Polifka Dr, Shaw Afb, SC 29152 2019-02-07
Find all providers in zip 29152

Taxonomy Information

Taxonomy Code 1223G0001X
Grouping Dental Providers
Classification Dentist
Specialization General Practice

Taxonomy Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
Notes: Source: Academy of General Dentistry

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1669088852 Matthew Dejong Dentist Kleber Dental Clinic, Bldg 3287, Apo, AE 09227 2020-09-22
1437712130 Andrea Rose Deese Dentist Raf Lakenheath 48 Mdg / Sghc, Unit 5115, Apo, AE 09461-5115 2019-04-17
1619440922 Joo Park Dentist Cmr 402 Unit 33301, Apo, AE 09180 2019-01-09
1760962252 Ian Alexander Milton Dentist Raf Lakenheath 48 Mdg/schc, Unit 5115, Apo, AE 09461-5115 2018-08-15
1164960365 Matthew Joseph Coen Dentist Psc 103 Box 553, Apo, AE 09603-0006 2017-02-08
1346655644 Andrew Woodward Hubbard Dentist Uss Bataan, Lhd-5, Fpo, AE 09554-1657 2014-06-25
1699016105 Sarah Elizabeth Joline Deveaux Dentist Psc 2 Box 9479, Apo, AE 09012-0095 2013-03-07
1053651547 Kara Elizabeth Dern Dentist Raf Alconbury 423mds/df, Apo, AE 09470 2013-02-21
1467704510 John P. Welnak Dentist Gebaude 700 Raum 40, Vilseck, Europe 92249 Germany, Apo, AE 92249 2012-10-12
1770832297 Stephen Kimball Dentist Psc 41 Box 2895, Apo, AE 09464-0029 2012-08-30
Find all providers with the same taxonomy

Competitor

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City SHAW AFB
Zip Code 29152

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Dataset Information

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.

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