Provider Demographics
NPI:1932289717
Name:BROTHER, DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:BROTHER
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 1:57 BEDFORD ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4500
Mailing Address - Country:US
Mailing Address - Phone:781-674-9995
Mailing Address - Fax:781-674-9944
Practice Address - Street 1:57 BEDFORD ST
Practice Address - Street 2:SUITE 110
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4500
Practice Address - Country:US
Practice Address - Phone:781-674-9995
Practice Address - Fax:781-674-9944
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA122051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice