Provider Demographics
NPI:1740203009
Name:BRODSKY, NEIL M (DDS)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:M
Last Name:BRODSKY
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 1:9303 SEMINOLE BLVD
Mailing Address - Street 2:#D
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-3100
Mailing Address - Country:US
Mailing Address - Phone:727-548-5454
Mailing Address - Fax:727-544-9800
Practice Address - Street 1:9303 SEMINOLE BLVD
Practice Address - Street 2:#D
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-3100
Practice Address - Country:US
Practice Address - Phone:727-548-5454
Practice Address - Fax:727-544-9800
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00121311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice