Provider Demographics
NPI:1386724490
Name:BRODELL, LYNNE SUSAN (DDS)
Entity type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:SUSAN
Last Name:BRODELL
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 1:12600 WINCHESTER RD SW
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6551
Mailing Address - Country:US
Mailing Address - Phone:301-729-0444
Mailing Address - Fax:301-729-0404
Practice Address - Street 1:12600 WINCHESTER RD SW
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-6551
Practice Address - Country:US
Practice Address - Phone:301-729-0444
Practice Address - Fax:301-729-0404
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD91211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice