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General NPI Number Information
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NPI Number | 1134509458
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Entity Type | Organization
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Legal Business Name | BROADWAY DENTAL CENTER, INC.
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Dates
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Enumeration Date | 06/02/2015
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Last Update Date | 06/02/2015
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Provider Practice Location Address
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Address Line | 310 HARVARD AVE. E.
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City | SEATTLE
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State | WA
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Zip | 98102
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Country | US
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Telephone | 206-324-1100
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Fax | 206-324-6711
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Provider Business Mailing Address
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Address Line | 310 HARVARD AVE. E.
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City | SEATTLE
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State | WA
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Zip | 98102
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Country | US
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Telephone | 206-324-1100
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Fax | 206-324-6711
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. STEPHEN DAVID BUCK
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Credential | DDS
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Telephone | 206-324-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 6274
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License Number State | WA
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