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MARK ANDREW BRODHAGEN DDS NPI 1760468136


NPI Information

NPI: 1760468136
Provider Name: MARK ANDREW BRODHAGEN, DDS
Classification: Dentist - 1223G0001X
Entity Type: Individual

Specialization: General Practice

PECOS Registration: Yes

Address:
1052 BEL AIRE CT
GREEN BAY, WI
ZIP 54304
Phone: (920) 499-2121
Get Directions

Mark Andrew Brodhagen, DDS is a general practice dentist in Green Bay, WI. The provider is 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. Mark Andrew Brodhagen, DDS NPI is 1760468136. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1052 BEL AIRE CT
GREEN BAY, WI
ZIP 54304-015
Phone: (920) 499-2121
Fax: (920) 499-7644

The NPI 1760468136 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 12/19/2005 and was last updated on 9/4/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1332BC3200XDurable Medical Equipment & Medical SuppliesCustomized Equipment1338GWISCONSINNo
21223G0001XDentistGeneral Practice1338GWISCONSINYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.