Provider Demographics
NPI:1881123453
Name:BROADY, ADAM (DDS)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:BROADY
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9002 N MERIDIAN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5350
Mailing Address - Country:US
Mailing Address - Phone:317-846-4980
Mailing Address - Fax:317-846-4982
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:317-846-4982
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012705A122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist