Provider Demographics
NPI:1992890156
Name:BROESS, MAARTEN (DMD)
Entity type:Individual
Prefix:DR
First Name:MAARTEN
Middle Name:
Last Name:BROESS
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 1:1414 ATWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-4839
Mailing Address - Country:US
Mailing Address - Phone:401-831-1414
Mailing Address - Fax:401-831-8666
Practice Address - Street 1:1414 ATWOOD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-4839
Practice Address - Country:US
Practice Address - Phone:401-831-1414
Practice Address - Fax:401-831-8666
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI024701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics