Provider Demographics
NPI:1639231210
Name:BRODSKY, JOEL F (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:F
Last Name:BRODSKY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 DEL AMO BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-1949
Mailing Address - Country:US
Mailing Address - Phone:562-496-2000
Mailing Address - Fax:562-497-2064
Practice Address - Street 1:5920 DEL AMO BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-1949
Practice Address - Country:US
Practice Address - Phone:562-496-2000
Practice Address - Fax:562-497-2064
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA242751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics