Provider Demographics
NPI:1598754392
Name:BROUDE, DAVID (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:BROUDE
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 HIGHWAY 55
Mailing Address - Street 2:STE 202
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-3734
Mailing Address - Country:US
Mailing Address - Phone:651-437-3262
Mailing Address - Fax:651-437-7684
Practice Address - Street 1:925 HIGHWAY 55
Practice Address - Street 2:STE 202
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-3734
Practice Address - Country:US
Practice Address - Phone:651-437-3262
Practice Address - Fax:651-437-7684
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND77271223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology