DRS Broderick Vaught & Dusek PC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DN012058 Issued in GA

Legal business name

DRS BRODERICK VAUGHT & DUSEK PC

Practice address

500 Eisenhower Drive
Savannah, GA 31406

Phone

(912) 355-7022

NPI assigned

Oct 14, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Thomas R Broderick, DDS MSNPI 1679901581

Title

Owner Partner

Phone

(912) 355-7022

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Thomas R Broderick Robert A Vaught Mark W Dusek Other name

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Thomas Broderick, D.D.S., M.S.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Savannah, GA
  • NPI 1679901581
  NPD (past) Authorized official
• Mark W Dusek, DDS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Savannah, GA
  • NPI 1003236407
  NPD (past)

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

{
    "created_epoch": "1160784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114017530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 EISENHOWER DRIVE",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "31406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 EISENHOWER DRIVE",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "31406",
            "telephone_number": "912-355-7022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRS BRODERICK VAUGHT & DUSEK PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRODERICK",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER PARTNER",
        "authorized_official_telephone_number": "912-355-7022",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS MS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "GA",
            "license": "DN010006",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "GA",
            "license": "DN011121",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "GA",
            "license": "DN012058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00536335A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Thomas R Broderick Robert A Vaught Mark W Dusek",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Cynthia Drown, NP
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• Paul James Drwiega, MD
• Michelle Ann Dubberly-McKinley, APRN, FNP
• Madison Jane Dubberly

• Orthodontics and Dentofacial Orthopedics Dentistry in Savannah, GA
• Providers in Savannah, GA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.