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General NPI Number Information
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NPI Number | 1639537616
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Entity Type | Organization
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Legal Business Name | BROADWAY FAMILY DENTAL PRESENTED BY DR. TARIQ SAYEGH BDS LLC
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Dates
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Enumeration Date | 02/04/2016
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 5716 BROADWAY AVENUE
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City | CLEVELAND
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State | OH
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Zip | 44127-1715
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Country | US
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Telephone | 216-862-4990
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Fax | 216-862-3585
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Provider Business Mailing Address
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Address Line | 5716 BROADWAY AVENUE
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City | CLEVELAND
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State | OH
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Zip | 44127-1715
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Country | US
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Telephone | 216-862-4990
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Fax | 216-862-3585
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. TARIQ SAYEGH SAYEGH
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Credential | D.D.S.
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Telephone | 14404543536
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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 |
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License Number State |
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