Provider Demographics
NPI:1053325423
Name:BRODIE, DAVID M (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:BRODIE
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 1:7 WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148
Mailing Address - Country:US
Mailing Address - Phone:781-321-4280
Mailing Address - Fax:781-321-4280
Practice Address - Street 1:7 WALNUT STREET
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148
Practice Address - Country:US
Practice Address - Phone:781-321-4280
Practice Address - Fax:781-321-4280
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice