Provider Demographics
NPI:1255939757
Name:BRODERICK, ASHLEY DAILEY (RDH)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:DAILEY
Last Name:BRODERICK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6955 WOOD GLEN DR
Mailing Address - Street 2:
Mailing Address - City:HUGHESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20637-2716
Mailing Address - Country:US
Mailing Address - Phone:240-427-8122
Mailing Address - Fax:
Practice Address - Street 1:3150 W WARD RD STE 304
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-3057
Practice Address - Country:US
Practice Address - Phone:410-257-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7598124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist