Provider Demographics
NPI:1437223682
Name:LYNNE S BRODELL DDS
Entity Type:Organization
Organization Name:LYNNE S BRODELL DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRODELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-729-0444
Mailing Address - Street 1:12600 WINCHESTER RD SW
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6551
Mailing Address - Country:US
Mailing Address - Phone:301-729-0444
Mailing Address - Fax:301-729-0404
Practice Address - Street 1:12600 WINCHESTER RD SW
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-6551
Practice Address - Country:US
Practice Address - Phone:301-729-0444
Practice Address - Fax:301-729-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD91211223G0001X
MD69931223G0001X
MD132741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD378654400Medicaid