Individual
BRYAN BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1027 2ND AVE, WORTHINGTON, MN 56187-2380
(507) 372-7339
Mailing address
1027 2ND AVE, WORTHINGTON, MN 56187-2380
(507) 372-7339
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D13492
MN
Other
Enumeration date
02/02/2015
Last updated
02/02/2015
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