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General NPI Number Information
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NPI Number | 1437223682
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Entity Type | Organization
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Legal Business Name | LYNNE S BRODELL DDS
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 08/20/2008
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Provider Practice Location Address
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Address Line | 12600 WINCHESTER RD SW
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City | LAVALE
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State | MD
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Zip | 21502-6551
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Country | US
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Telephone | 301-729-0444
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Fax | 301-729-0404
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Provider Business Mailing Address
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Address Line | 12600 WINCHESTER RD SW
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City | LAVALE
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State | MD
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Zip | 21502-6551
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Country | US
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Telephone | 301-729-0444
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Fax | 301-729-0404
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LYNNE S BRODELL
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Credential | D.D.S.
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Telephone | 301-729-0444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6993
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 13274
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9121
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License Number State | MD
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