Individual
MARK ANDREW BRODHAGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1052 BEL AIRE CT, GREEN BAY, WI 54304-5015
(920) 499-2121
(920) 499-7644
Mailing address
1052 BEL AIRE CT, GREEN BAY, WI 54304-5015
(920) 499-2121
(920) 499-7644
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1338G
WI
332B00000X
Durable Medical Equipment & Medical Supplies
1338G
WI
332BC3200X
Customized Equipment (DME)
1338G
WI
Other
Enumeration date
12/19/2005
Last updated
04/13/2026
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