Provider Demographics
NPI:1104911775
Name:JOHN J. BRODNER
Entity type:Organization
Organization Name:JOHN J. BRODNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:BRODNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-746-7600
Mailing Address - Street 1:399 TEQUESTA DR.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-3087
Mailing Address - Country:US
Mailing Address - Phone:561-746-7600
Mailing Address - Fax:561-743-9884
Practice Address - Street 1:399 TEQUESTA DR.
Practice Address - Street 2:SUITE 103
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-3087
Practice Address - Country:US
Practice Address - Phone:561-746-7600
Practice Address - Fax:561-743-9884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN149991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty