Provider Demographics
NPI:1285060632
Name:BROADSWORD, ANDREW MICHAEL (DMD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MICHAEL
Last Name:BROADSWORD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NE MULTNOMAH ST STE 880
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-4118
Mailing Address - Country:US
Mailing Address - Phone:503-230-1234
Mailing Address - Fax:503-239-7741
Practice Address - Street 1:700 NE MULTNOMAH ST STE 880
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-4118
Practice Address - Country:US
Practice Address - Phone:503-230-1234
Practice Address - Fax:503-239-7741
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD99611223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics