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General NPI Number Information
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NPI Number | 1063591931
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Entity Type | Individual
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Provider Name | ALEXANDER GREGORY BRODSKY DMD
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Gender | Male
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3653 SE 34TH AVE
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City | PORTLAND
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State | OR
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Zip | 97202-3034
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Country | US
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Telephone | 503-988-4410
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Fax | 503-988-5642
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Provider Business Mailing Address
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Address Line | 10618 SW 43RD AVE
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City | PORTLAND
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State | OR
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Zip | 97219-6992
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Country | US
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Telephone | 503-488-5984
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | D7465
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License Number State | OR
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