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NPI Code Detail

MEDICARE: JENNIFER BROTZ DMD

MEDICARE: JENNIFER BROTZ DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
21223G0001XGeneral Practice Dentistry16316MD

General Provider Information

NPI Number : 1942748801
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER BROTZ DMD
Provider Business Mailing Address
First Line : 22 KENT TOWN MARKET
Second Line :
City : CHESTER
State : MD
Zip : 21619-2632
Country : US
Telephone Number : 410-643-5500
Fax Number :
Provider Business Practice Location Address
First Line : 22 KENT TOWN MARKET
Second Line :
City : CHESTER
State : MD
Zip : 21619-2632
Country : US
Telephone Number : 410-643-5500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2017
Last Update Date : 05/03/2022

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