Healthcare Provider Details

I. General information

NPI: 1770111577
Provider Name (Legal Business Name): ASHLEY E BRODIGAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY E BRODEUR

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 WEST ST STE 202
DANBURY CT
06810-6517
US

IV. Provider business mailing address

47 WEST ST STE 202
DANBURY CT
06810-6517
US

V. Phone/Fax

Practice location:
  • Phone: 203-323-5439
  • Fax:
Mailing address:
  • Phone: 203-323-5439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number14207
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: