Provider Demographics
NPI:1730304858
Name:BRODSKY, LISA MARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARY
Last Name:BRODSKY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:STE. 805
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6501
Mailing Address - Country:US
Mailing Address - Phone:770-814-7533
Mailing Address - Fax:770-814-7527
Practice Address - Street 1:3455 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:STE. 805
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-6501
Practice Address - Country:US
Practice Address - Phone:770-814-7533
Practice Address - Fax:770-814-7527
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9902122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist