Provider Demographics
NPI:1174748669
Name:FRODGE, BRANDON DALE (DMD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:DALE
Last Name:FRODGE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1418 DRESDEN DR NE
Mailing Address - Street 2:UNIT 205
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-7000
Mailing Address - Country:US
Mailing Address - Phone:404-618-0380
Mailing Address - Fax:
Practice Address - Street 1:5075 PEACHTREE PKWY
Practice Address - Street 2:SUITE 105-B
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-6508
Practice Address - Country:US
Practice Address - Phone:770-448-9333
Practice Address - Fax:678-990-0359
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GADN0134841223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics