Organization
DRS BRODERICK VAUGHT & DUSEK PC
Active
Other names
Thomas R Broderick Robert A Vaught Mark W Dusek
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS R BRODERICK DDS MS (OWNER PARTNER)
(912) 355-7022
Entity
Organization
Contact information
Practice address
500 EISENHOWER DRIVE, SAVANNAH, GA 31406
(912) 355-7022
Mailing address
500 EISENHOWER DRIVE, SAVANNAH, GA 31406
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
DN010006
GA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
DN011121
GA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN012058
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00536335A
—
GA
Enumeration date
10/14/2006
Last updated
08/22/2020
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