Individual
DR. KEVIN BRODERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
14111 PACIFIC ST, OMAHA, NE 68154-2863
(402) 896-9112
Mailing address
415 LEAVENWORTH ST APT 631, OMAHA, NE 68102-2991
(402) 314-3838
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7477
NE
Other
Enumeration date
06/19/2018
Last updated
06/19/2018
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