Provider Demographics
NPI:1033950605
Name:BRODZIK, ABIGAEL BROOKE (DMD)
Entity type:Individual
Prefix:DR
First Name:ABIGAEL
Middle Name:BROOKE
Last Name:BRODZIK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 CELIA LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2201
Mailing Address - Country:US
Mailing Address - Phone:859-707-4787
Mailing Address - Fax:
Practice Address - Street 1:2020 ALVERSON DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-2205
Practice Address - Country:US
Practice Address - Phone:859-987-4775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11112122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist