Provider Demographics
NPI:1639284235
Name:BROERE, PAUL THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:THOMAS
Last Name:BROERE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8884 NW ANDERSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7323
Mailing Address - Country:US
Mailing Address - Phone:360-698-6809
Mailing Address - Fax:
Practice Address - Street 1:9692 LEVIN RD NW STE 101
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7801
Practice Address - Country:US
Practice Address - Phone:360-692-1208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA71041223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics