Individual
DR. THOMAS BRODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
500 EISENHOWER DR, SAVANNAH, GA 31406-2608
(912) 355-7022
(912) 355-1415
Mailing address
500 EISENHOWER DR, SAVANNAH, GA 31406-2608
(912) 355-7022
(912) 355-1415
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
10006
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114017530
GROUP NPI
GA
01
—
GA10006
LICENSE
GA
Enumeration date
10/31/2013
Last updated
10/31/2013
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