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General NPI Number Information
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NPI Number | 1346739430
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Entity Type | Organization
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Legal Business Name | BROADWAY SMILES DENTAL PC
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 05/04/2018
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Provider Practice Location Address
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Address Line | 105 STEVENS AVE STE 302
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City | MOUNT VERNON
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State | NY
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Zip | 10550-2680
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Country | US
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Telephone | 914-664-5955
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Fax |
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Provider Business Mailing Address
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Address Line | 105 STEVENS AVE STE 302
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City | MOUNT VERNON
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State | NY
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Zip | 10550-2680
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Country | US
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Telephone | 914-664-5955
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | MRS. PUSHPA NAIK
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Credential | DDS
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Telephone | 914-664-5955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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