Provider Demographics
NPI:1356741284
Name:BROADY, ROBERT LEE SR (DDS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEE
Last Name:BROADY
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3533 DUNN ROAD
Mailing Address - Street 2:SUITE 242
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033
Mailing Address - Country:US
Mailing Address - Phone:314-831-9992
Mailing Address - Fax:314-831-9994
Practice Address - Street 1:3533 DUNN ROAD
Practice Address - Street 2:SUITE 242
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033
Practice Address - Country:US
Practice Address - Phone:314-831-9992
Practice Address - Fax:314-831-9994
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO0129801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice