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Contact Information

MARK BRODHAGEN DDS SC
1052 BEL AIRE COURT
GREEN BAY, WI54304
 Phone: 920-499-2121
 Fax: 920-499-7644
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for MARK BRODHAGEN DDS SC

NPI # 1164500591
LBN Legal business name MARK BRODHAGEN DDS SC
Authorized official MARK BRODHAGEN - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 11/02/2006
Last updated 11/16/2016 - About 10 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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