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NPI Code Detail

MEDICARE: BROADWAY DENTAL CARE

MEDICARE: BROADWAY DENTAL CARE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry2891WA

General Provider Information

NPI Number : 1376580423
Entity Type Code : Organization
Provider Name (Legal Business Name) : BROADWAY DENTAL CARE
Provider Business Mailing Address
First Line : 1534 BROADWAY
Second Line :
City : SEATTLE
State : WA
Zip : 98122-3811
Country : US
Telephone Number : 206-323-7727
Fax Number : 206-323-0733
Provider Business Practice Location Address
First Line : 1534 BROADWAY
Second Line :
City : SEATTLE
State : WA
Zip : 98122-3811
Country : US
Telephone Number : 206-323-7727
Fax Number : 206-323-0733
Authorized Official
Title or Position : OWNER
Name : DR. EDWARD GEORGE SUTTER SR.
Credential : DDS
Telephone Number : 206-323-7727
Provider Enumeration Date : 05/31/2006
Last Update Date : 08/22/2020

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Directions to “BROADWAY DENTAL CARE ” Practice Location

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