Provider Demographics
NPI:1831419456
Name:BRODERICK, ANNE LINDSEY (DMD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:LINDSEY
Last Name:BRODERICK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15660 SW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2233
Mailing Address - Country:US
Mailing Address - Phone:954-558-4635
Mailing Address - Fax:
Practice Address - Street 1:7011 CYPRESS TER
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-8800
Practice Address - Country:US
Practice Address - Phone:954-558-4635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2014-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 194111223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics