MEDICARE: ON BROADWAY DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QD0000X	Dental Clinic/Center
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1851857064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ON BROADWAY DENTISTRY

Provider Business Mailing Address
First Line	:	3658 E MORRISON RANCH PKWY
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-1816
Country	:	US
Telephone Number	:	480-636-0170
Fax Number	:

Provider Business Practice Location Address
First Line	:	4435 E BROADWAY RD # 9
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-2012
Country	:	US
Telephone Number	:	480-223-0255
Fax Number	:	480-654-0705

Authorized Official
Title or Position	:	CEO
Name	:	BENNETT MANKIN
Credential	:
Telephone Number	:	480-636-0170

Provider Enumeration Date	:	02/12/2019
Last Update Date	:	02/07/2020

Similar Medicare Providers

1790771251 — SHERRY LYNN FORSYTH CARTER MC, LPC
Practice Location Address:

4435 E BROADWAY RD STE 3
MESA, AZ
85206-2012

Practice Phone: 480-888-6223
Practice Fax:

1487792594 — FAMILY TOOTH DOCTOR LL, LLC
Practice Location Address:

4435 E BROADWAY RD , SUITE 9
MESA, AZ
85206-2012

Practice Phone: 480-223-0255
Practice Fax: 480-654-0705

1598987869 — MS. DENISE JENDERZAK DACM, L.AC.
Practice Location Address:

4435 E BROADWAY RD STE 4
MESA, AZ
85206-2012

Practice Phone: 480-832-0966
Practice Fax:

1801273818 — GENTLE TOOTH DOCTOR PLLC
Practice Location Address:

4435 E BROADWAY RD # 9
MESA, AZ
85206-2012

Practice Phone: 480-397-0635
Practice Fax:

1063005049 — DENTAL SPECIALTY GROUP INC
Practice Location Address:

4435 E BROADWAY RD STE 7
MESA, AZ
85206-2012

Practice Phone: 480-471-8480
Practice Fax: 480-654-0705

1407576549 — JOSHUA ALSTON LMFT
Practice Location Address:

4435 E BROADWAY RD STE 3
MESA, AZ
85206-2012

Practice Phone: 602-759-0512
Practice Fax:

Directions to “ON BROADWAY DENTISTRY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.