NPI 1205032356

Todd Richard Broyles, DDS

Practitioner Dentist Scott Afb, IL

Practice location

Address: 310 W Losey St, Scott Afb, IL 62225-5250
Phone: (618) 256-6667
Mailing address: 561 W Carlton Ave, Meridian, ID 83642-2124

Registered specialties

Dentist Primary

Dental Providers Taxonomy 122300000X Licence D-4068 (ID)

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Registry record

NPI: 1205032356
Entity type: Individual
Sex (as registered): Male
NPI issued: 25 Jun 2007
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.