Maryam Brazdo, DMD, PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN18392 Issued in FL

Legal business name

MARYAM BRAZDO, DMD, PA

Practice address

1061 S Wickham Rd
Melbourne, FL 32904-1652

Phone

(321) 724-1400

NPI assigned

Mar 21, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Maryam Brazdo, DMDNPI 1265694236

Title

President

Phone

(321) 243-2030

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Maryam Brazdo, DMD

  • Dentist
  • Melbourne, FL
  • NPI 1265694236
  NPD (past) Authorized official
• Janice G Wahl, DMD

  • General Practice Dentistry
  • West Melbourne, FL
  • NPI 1396856795
  NPD (past)

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

{
    "created_epoch": "1332288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332288000000",
    "number": "1295000339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1061 S WICKHAM RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329041652",
            "telephone_number": "321-724-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1061 S WICKHAM RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329041652",
            "telephone_number": "321-724-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYAM BRAZDO, DMD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-21",
        "last_updated": "2012-03-21",
        "status": "A",
        "authorized_official_last_name": "BRAZDO",
        "authorized_official_first_name": "MARYAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-243-2030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN18392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alan K Marumoto, MD
• Sherry Marvinny
• Mary E Digiorgio, Aprn-BC, MSN,PLC Incorporated Dba Nexxus Health Partners
• Mary L Miller, M.a., P.a.
• Mary L. Kalimnios, D.M.D.
• Peter M Marzano III, MD
• Rebecca Marzouca, O.D.
• Shannon D Marzouk, APRN
• Aneal S. Masih, M.D.
• Diana G. Masker, CCC/SLP

• General Practice Dentistry in Melbourne, FL
• Providers in Melbourne, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2012; 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.