Provider Demographics
NPI:1093749426
Name:BROERING, RICHARD P JR (DMD, MS, PSC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:P
Last Name:BROERING
Suffix:JR
Gender:M
Credentials:DMD, MS, PSC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3005 DIXIE HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2352
Mailing Address - Country:US
Mailing Address - Phone:859-344-8000
Mailing Address - Fax:859-344-8001
Practice Address - Street 1:3005 DIXIE HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-2352
Practice Address - Country:US
Practice Address - Phone:859-344-8000
Practice Address - Fax:859-344-8001
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY62511223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics