Provider Demographics
NPI:1104978030
Name:BRODFUEHRER, JAMES SEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:SEAN
Last Name:BRODFUEHRER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9225 MIRA MESA BLVD
Mailing Address - Street 2:SUITE #212
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4811
Mailing Address - Country:US
Mailing Address - Phone:858-566-9452
Mailing Address - Fax:858-566-9967
Practice Address - Street 1:9225 MIRA MESA BLVD
Practice Address - Street 2:SUITE #212
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4811
Practice Address - Country:US
Practice Address - Phone:858-566-9452
Practice Address - Fax:858-566-9967
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37535122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist