Provider Demographics
NPI:1780254847
Name:BROCK, ROBERT LANSDEN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LANSDEN
Last Name:BROCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 SHELLEY DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8725
Mailing Address - Country:US
Mailing Address - Phone:903-561-8600
Mailing Address - Fax:
Practice Address - Street 1:202 SHELLEY DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8725
Practice Address - Country:US
Practice Address - Phone:903-561-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37386122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist