Provider Demographics
NPI:1962625749
Name:RICHARD A. BROGADIR, D.M.D. P.C.
Entity type:Organization
Organization Name:RICHARD A. BROGADIR, D.M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BROGADIR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-736-2961
Mailing Address - Street 1:258 WAKELEE AVE
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-1244
Mailing Address - Country:US
Mailing Address - Phone:203-736-2961
Mailing Address - Fax:
Practice Address - Street 1:258 WAKELEE AVE
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1244
Practice Address - Country:US
Practice Address - Phone:203-736-2961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty