MEDICARE: BROADVIEW DENTISTRY 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1881169472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROADVIEW DENTISTRY LLC

Provider Business Mailing Address
First Line	:	9341 BROADVIEW RD
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-2305
Country	:	US
Telephone Number	:	440-526-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	9341 BROADVIEW RD
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-2305
Country	:	US
Telephone Number	:	440-526-1000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MAJDI I ALRABADY
Credential	:	DDS
Telephone Number	:	440-526-1000

Provider Enumeration Date	:	10/10/2018
Last Update Date	:	10/10/2018

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