Provider Demographics
NPI:1770835969
Name:BROSSMAN, MICHAEL A (DMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:BROSSMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 BEL AIRE CT
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5014
Mailing Address - Country:US
Mailing Address - Phone:920-499-2121
Mailing Address - Fax:
Practice Address - Street 1:1052 BEL AIRE CT
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5014
Practice Address - Country:US
Practice Address - Phone:920-499-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001465122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist