Organization
MARK BRODHAGEN DDS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK ANDREW BRODHAGEN DDS (OWNER)
(920) 499-2121
Entity
Organization
Contact information
Practice address
1052 BEL AIRE COURT, GREEN BAY, WI 54304
(920) 499-2121
(920) 499-7644
Mailing address
1052 BEL AIRE COURT, GREEN BAY, WI 54304
(920) 499-2121
(920) 499-7644
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/02/2006
Last updated
11/16/2016
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