Healthcare Provider Details

I. General information

NPI: 1386771822
Provider Name (Legal Business Name): ALAN H. BRODINE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 LINDEN OAKS STE 340
ROCHESTER NY
14625-2839
US

IV. Provider business mailing address

107 KNOLLWOOD DR
ROCHESTER NY
14618-3514
US

V. Phone/Fax

Practice location:
  • Phone: 585-248-8580
  • Fax: 585-248-8643
Mailing address:
  • Phone: 585-383-8005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number037083
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: