Thomas Broderick, D.D.S., M.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

10006 Issued in GA

Practice address

500 Eisenhower Dr
Savannah, GA 31406-2608

Phone

(912) 355-7022

Fax

(912) 355-1415

NPI assigned

Oct 31, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• DRS Broderick Vaught & Dusek PC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Savannah, GA
  • NPI 1114017530
  NPD (past) Authorized official

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

{
    "created_epoch": "1383177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383177600000",
    "number": "1679901581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 EISENHOWER DR",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314062608",
            "telephone_number": "912-355-7022",
            "fax_number": "912-355-1415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 EISENHOWER DR",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314062608",
            "telephone_number": "912-355-7022",
            "fax_number": "912-355-1415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-10-31",
        "last_updated": "2013-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "GA",
            "license": "10006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "GA10006",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1114017530",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Brannen Brock, L.C.S.W
• Gina Brock, DO
• Matthew Brockman
• Kristin E Broderick, LPC, CAADC
• Patrick Thomas Broderick, MD
• Deveney Brodersen, RBT
• Sonia Brodeur-Lyons, OT
• Benjamin Richard Brodhead, L.AC.
• Elizabeth House Brodhead, LCSW
• Laura Taylor Brodmann, PHARMD

• 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 Oct 31, 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.

Verify at the official NPI Registry.