Healthcare Provider Details

I. General information

NPI: 1043265028
Provider Name (Legal Business Name): ARTHUR BROAD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5237 WARRENSVILLE CENTER RD
MAPLE HEIGHTS OH
44137-1911
US

IV. Provider business mailing address

5237 WARRENSVILLE CENTER RD
MAPLE HEIGHTS OH
44137-1911
US

V. Phone/Fax

Practice location:
  • Phone: 216-663-9220
  • Fax:
Mailing address:
  • Phone: 216-663-9220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number15305
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: