Nicole Ashley Broz
Individual provider Active NPI General Practice Dentistry · Wauwatosa, WI
NPI 1124870910 · NPPES record last updated Jul 2, 2024
Key facts
- NPI
- 1124870910
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 6001599 (WI)
- Practice address
- 11904 W North Ave
Wauwatosa, WI 53226-2062 - Phone
- (414) 206-3356
- NPI assigned
- Apr 4, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6001599 | WI | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6001599 | WI | Yes |
Addresses
Primary practice location
11904 W North Ave
Wauwatosa, WI 53226-2062
Mailing address
11904 W North Ave
Wauwatosa, WI 53226-2062
Other practice location 1
1801 W Wisconsin Ave
Milwaukee, WI 53233-2186
Phone (262) 716-8468
Other providers in Wauwatosa, WI
- Jillian Brooks
- Ann M Brophy
- Jordan Brown
- Laquanda Brown
- Sylvia Brown
- Suellen Brueckner
- Walter Brummund
- Nicholas J Bruns
- Olivia E Bruss
- William Elmer Brylow
All providers in Wauwatosa, WI · General Practice Dentistry in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 2, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.