Healthcare Provider Details

I. General information

NPI: 1699863985
Provider Name (Legal Business Name): HOWARD BROISMAN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 US ROUTE 1 SUITE 2
SCARBOROUGH ME
04074-7400
US

IV. Provider business mailing address

243 US ROUTE 1 SUITE 2
SCARBOROUGH ME
04074-7400
US

V. Phone/Fax

Practice location:
  • Phone: 207-883-8911
  • Fax: 207-883-6915
Mailing address:
  • Phone: 207-883-8911
  • Fax: 207-883-6915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2539
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: