Individual
TINA ANDREA BRODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
6401 S RICHARDS AVE, SANTA FE, NM 87508-4887
(505) 984-5048
(505) 988-3246
Mailing address
PO BOX 5395, SANTA FE, NM 87502-5395
(505) 984-5048
(505) 988-3246
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH1049
NM
124Q00000X
Dental Hygienist
—
—
Other
Enumeration date
07/22/2021
Last updated
07/22/2021
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