Provider Demographics
NPI:1295830438
Name:BRODY, ROBERT ALAN (DMD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALAN
Last Name:BRODY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20295 NW 2ND AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2550
Mailing Address - Country:US
Mailing Address - Phone:305-652-6313
Mailing Address - Fax:305-652-9940
Practice Address - Street 1:140 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-2234
Practice Address - Country:US
Practice Address - Phone:954-431-0004
Practice Address - Fax:954-431-6194
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI030086001223G0001X
NY0637441223G0001X
CT139341223G0001X
FLDN102191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice