Provider Demographics
NPI:1255954913
Name:ADAM B BROADY DDS MSD & ASSOCIATES LLC
Entity type:Organization
Organization Name:ADAM B BROADY DDS MSD & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:BROADY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:317-217-9077
Mailing Address - Street 1:620 E 53RD ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3130
Mailing Address - Country:US
Mailing Address - Phone:317-217-9077
Mailing Address - Fax:
Practice Address - Street 1:9002 N MERIDIAN ST STE 201
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5350
Practice Address - Country:US
Practice Address - Phone:317-846-4980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty