Mark Brodhagen DDS Sc

NPI #1164500591 in Green Bay, Wisconsin

Provider Information

NPI Number: 1164500591
Entity Type: Organization
Organization Name: Mark Brodhagen DDS Sc
Primary Specialty: Dentist - General Practice
Enumeration Date: Nov 2, 2006
Last Updated: Nov 16, 2016

Practice Location

Address: 1052 BEL AIRE COURT
City: Green Bay
State: Wisconsin
ZIP Code: 54304
Phone: (920) 499-2121

Authorized Official

Name: MR. MARK ANDREW BRODHAGEN, DDS
Title: OWNER
Phone: (920) 499-2121

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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