Mark Andrew Brodhagen, DDS
Dentist in Green Bay, WI. Individual provider (NPI-1).
NPI number1760468136
StatusActive
Last updated in NPPESAug 11, 2026
Details
- NPI
- 1760468136
- Entity type
- Individual (NPI-1)
- Name
- Mark Andrew Brodhagen
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Dec 19, 2005
- Certification date
- Aug 11, 2026
- Last updated
- Aug 11, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 1338G | WI | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 1338G | WI |
Practice location
1052 Bel Aire CtGreen Bay, WI 54304-5015
Phone 920-499-2121 · Fax 920-499-7644
Mailing address
1052 Bel Aire CtGreen Bay, WI 54304-5015
Phone 920-499-2121 · Fax 920-499-7644
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