Nick Brodak, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN123534 Issued in GA

Practice address

244 S Main St
Reidsville, GA 30453-4602

Phone

(912) 577-6307

NPI assigned

Jul 22, 2024

Last updated

Jul 22, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1023846128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 S MAIN ST",
            "city": "REIDSVILLE",
            "state": "GA",
            "postal_code": "304534602",
            "telephone_number": "912-577-6307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 S MAIN ST",
            "city": "REIDSVILLE",
            "state": "GA",
            "postal_code": "304534602",
            "telephone_number": "912-577-6307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODAK",
        "first_name": "NICK",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-22",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN123534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol Ann Alexander
• Douglas O. Baxley, CRNA
• Brianna Mikkea Beal, CCMA
• Reggie Bennett, CAA
• Gregory Bernstein
• Barbie Jenine Carpenter, FNP
• Sharon J Carter, FNP
• Benjamin Addril Clark, RPH
• Claxton Family Dentistry LLC (Reidsville Family Dentistry)
• Janet Paulette Cohen Miller, CRNA

• General Practice Dentistry in Reidsville, GA
• Providers in Reidsville, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.