Robert L Broady DDS PC

Primary specialty

DentistTaxonomy code 122300000X

License

12980 Issued in MO

Legal business name

ROBERT L BROADY DDS PC

Practice address

158 Mayfair Plaza
Florissant, MO 63033-8008

Phone

(314) 355-5851

Fax

(314) 355-5852

NPI assigned

Feb 27, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Robert Lee Broady, DDS

Title

President

Phone

(314) 355-5851

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780650069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 MAYFAIR PLAZA",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630338008",
            "telephone_number": "314-355-5851",
            "fax_number": "314-355-5852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 MAYFAIR PLAZA",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630338008",
            "telephone_number": "314-355-5851",
            "fax_number": "314-355-5852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT L BROADY DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROADY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-355-5851",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MO",
            "license": "12980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Florissant, MO
• Providers in Florissant, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.