Aaron Daniel Broderick, D.M.D.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DN 19413 Issued in FL

Practice address

10580 Colonial Blvd Ste 103
Fort Myers, FL 33913-8703

Phone

(239) 210-2926

Fax

(239) 332-0942

NPI assigned

Jun 10, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

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

{
    "created_epoch": "1276128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646352000000",
    "number": "1902126147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9250 COLLEGE PKWY",
            "address_2": "STE 1",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339194847",
            "telephone_number": "293-437-4014",
            "fax_number": "239-437-0306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10580 COLONIAL BLVD STE 103",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339138703",
            "telephone_number": "239-210-2926",
            "fax_number": "239-332-0942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "AARON",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-10",
        "last_updated": "2022-03-04",
        "certification_date": "2022-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "DN 19413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandria Danielle Broadway, CNM
• Gabriel Broche, DMD
• Brock S Frear DC PLLC
• Ann V Brock, P.A.
• Gabriella Brock, PHARM.D.
• Anne Lindsey Broderick, D.M.D
• Margarita Brodskaya, FNP
• Julie Yolanda Bronson, FNP-C
• Brookdale Senior Living Communities, Inc
• Brookdale Senior Living Communities, Inc.

• Periodontics in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Periodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2022; 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.