Provider Demographics
NPI:1194811992
Name:BRODY, ALAN RAY (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RAY
Last Name:BRODY
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12520 MAGNOLIA BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2344
Mailing Address - Country:US
Mailing Address - Phone:818-762-2682
Mailing Address - Fax:818-762-3490
Practice Address - Street 1:12520 MAGNOLIA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-2344
Practice Address - Country:US
Practice Address - Phone:818-762-2682
Practice Address - Fax:818-762-3490
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA216931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice