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).
| 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 |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
109446829921 | UT | Dental Providers |
| Street Address |
SHAW AFB DENTAL CLINIC |
| City | SHAW AFB |
| State | AE |
| Zip Code | 29152 |
| 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 Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| 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 |
| 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 | ||||
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| 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.