Provider Demographics
NPI:1184833758
Name:BRODY, JEFFREY H (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:H
Last Name:BRODY
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 1:6480 MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5852
Mailing Address - Country:US
Mailing Address - Phone:716-868-5095
Mailing Address - Fax:
Practice Address - Street 1:6480 MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5852
Practice Address - Country:US
Practice Address - Phone:716-868-5095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0337631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice