Provider Demographics
NPI:1508877333
Name:BRODY, L SCOTT (DDS PC)
Entity Type:Individual
Prefix:
First Name:L
Middle Name:SCOTT
Last Name:BRODY
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 S PERRY ST STE 105
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-3365
Mailing Address - Country:US
Mailing Address - Phone:303-688-2229
Mailing Address - Fax:303-688-6023
Practice Address - Street 1:1025 S PERRY ST STE 105
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-3365
Practice Address - Country:US
Practice Address - Phone:303-688-2229
Practice Address - Fax:303-688-6023
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice