Active NPI
Bennett Roy Brodwin, DMD
- Dentist
- Berkeley, CA
National Provider Identifier
1548301153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 29215
- Practice address
- 900 Colusa Ave
Suite 205a
Berkeley, CA 94707-2319 - Phone
- (510) 525-4847
- NPI assigned
- Feb 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 29215 | CA | Primary |
Addresses
Primary practice location
900 Colusa Ave
Suite 205a
Berkeley, CA 94707-2319
Mailing address
900 Colusa Ave
Suite 205a
Berkeley, CA 94707-2319
Phone (510) 525-4847
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29215 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377648000000",
"number": "1548301153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 COLUSA AVE",
"address_2": "SUITE 205A",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947072319",
"telephone_number": "510-525-4847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 COLUSA AVE",
"address_2": "SUITE 205A",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947072319",
"telephone_number": "510-525-4847"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODWIN",
"first_name": "BENNETT",
"middle_name": "ROY",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-08",
"last_updated": "2013-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "29215",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.