Brodhagen, Mark Andrew
Brodhagen, Mark Andrew is an sole proprietor health care provider with primary practice located at 1052 Bel Aire Ct , Green Bay WI 54304-5015. He recently has 2 registered licenses in different health care specialties including Suppliers / Customized Equipment, Dental Providers / General Practice. Dental Providers / General Practice is his primary health care specialty. Brodhagen, Mark Andrew can be contacted via phone (920) 499-2121.Contact Information
Primary practice address
1052 Bel Aire Ct
Green Bay WI 54304-5015
Phone: (920) 499-2121
Fax: (920) 499-7644
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Customized Equipment | 332BC3200X | 1338G | Wisconsin |
| Dental Providers / General Practice | 1223G0001X | 1338G | Wisconsin |
Profile Details
| NPI number | 1760468136 |
|---|---|
| LBN Legal business name | Brodhagen, Mark Andrew |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 19th, 2005 |
| Last updated | Sep 4th, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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