Provider Demographics
NPI:1831391341
Name:BRODACH, GILBERT M (DMD)
Entity type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:M
Last Name:BRODACH
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 1:7206 NW 52 TERRACE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-7006
Mailing Address - Country:US
Mailing Address - Phone:352-213-1955
Mailing Address - Fax:
Practice Address - Street 1:175 NW 138TH TER
Practice Address - Street 2:UNIT 200
Practice Address - City:JONESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32669-2091
Practice Address - Country:US
Practice Address - Phone:352-332-3080
Practice Address - Fax:352-333-3729
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10885122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist