Mark Brodhagen DDS SC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MARK BRODHAGEN DDS SC

Practice address

1052 Bel Aire Court
Green Bay, WI 54304

Phone

(920) 499-2121

Fax

(920) 499-7644

NPI assigned

Nov 2, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Mark Andrew Brodhagen, DDSNPI 1760468136

Title

Owner

Phone

(920) 499-2121

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Andrew Brodhagen, DDS

  • Dentist
  • Green Bay, WI
  • NPI 1760468136

  General Practice

  NPD (past) Authorized official

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479254400000",
    "number": "1164500591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1052 BEL AIRE COURT",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54304",
            "telephone_number": "920-499-2121",
            "fax_number": "920-499-7644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1052 BEL AIRE COURT",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54304",
            "telephone_number": "920-499-2121",
            "fax_number": "920-499-7644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK BRODHAGEN DDS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2016-11-16",
        "status": "A",
        "authorized_official_last_name": "BRODHAGEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-499-2121",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony Joseph Marchlewski, MD
• Amber Marciniak
• Timothy Joseph Marciniak, H.I.S.
• Chester Marcol
• Christina Anne Marien
• Holli J Marklein, RN
• Victoria Marie Markowski, MS, ATR, LPC-IT
• Marla Vista Manor Assisted Living of Green Bay, LLC
• Myron M Marlett, MD
• Kim Marohl, MA, LPC

• General Practice Dentistry in Green Bay, WI
• Providers in Green Bay, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2016; 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.