Provider Demographics
NPI:1548755481
Name:BRODSKY, ANDREW IAN (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:IAN
Last Name:BRODSKY
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3426
Mailing Address - Country:US
Mailing Address - Phone:617-696-7257
Mailing Address - Fax:617-696-6635
Practice Address - Street 1:25 HIGH ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3426
Practice Address - Country:US
Practice Address - Phone:617-696-7257
Practice Address - Fax:617-696-6635
Is Sole Proprietor?:No
Enumeration Date:2018-06-23
Last Update Date:2018-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18580221223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics