Mark Andrew Brodhagen, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

1338G Issued in WI

Practice address

1052 Bel Aire CT
Green Bay, WI 54304-5015

Phone

(920) 499-2121

Fax

(920) 499-7644

NPI assigned

Dec 19, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Mark Brodhagen DDS SC

  • General Practice Dentistry
  • Green Bay, WI
  • NPI 1164500591

  General Practice

  NPD (past) Authorized official
• Sleep Health Wisconsin LLC

  • Durable Medical Equipment & Medical Supplies
  • Green Bay, WI
  • NPI 1427762533

  Dentist

  NPD (past)

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

{
    "created_epoch": "1134950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786406400000",
    "number": "1760468136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1052 BEL AIRE CT",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045015",
            "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 CT",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045015",
            "telephone_number": "920-499-2121",
            "fax_number": "920-499-7644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODHAGEN",
        "first_name": "MARK",
        "middle_name": "ANDREW",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-19",
        "last_updated": "2026-08-11",
        "certification_date": "2026-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "1338G",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WI",
            "license": "1338G",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise Mary Brilliant, NP
• Bristol Hospice - Green Bay, L.L.C.
• Nylene Brittain, CNM
• Michael J Brockman, MD
• Erin Joanne Broda, CNM
• Abigail Brooks, MD
• David J. Brooks, M.D.
• Katelyn Marie Brosig
• Michael A. Brossman, DMD
• Brown County

• All providers in Green Bay, WI
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.