MEDICARE: BROADWAY FAMILY DENTAL PRESENTED BY DR. TARIQ SAYEGH BDS LLC

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
1	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639537616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROADWAY FAMILY DENTAL PRESENTED BY DR. TARIQ SAYEGH BDS LLC

Provider Business Mailing Address
First Line	:	5716 BROADWAY AVENUE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44127-1715
Country	:	US
Telephone Number	:	216-862-4990
Fax Number	:	216-862-3585

Provider Business Practice Location Address
First Line	:	5716 BROADWAY AVENUE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44127-1715
Country	:	US
Telephone Number	:	216-862-4990
Fax Number	:	216-862-3585

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. TARIQ SAYEGH SAYEGH
Credential	:	D.D.S.
Telephone Number	:	14404543536

Provider Enumeration Date	:	02/04/2016
Last Update Date	:	02/04/2016

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