Provider Demographics
NPI:1487965836
Name:BRODEUR, MARILYN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:BRODEUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N HOWARD STREET
Mailing Address - Street 2:APT 602
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:BLALOCK 266
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-3424
Practice Address - Country:US
Practice Address - Phone:410-905-2917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDNA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist