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NPI Code Detail

MEDICARE: WEST BROAD DENTAL PARTNERS LLP

MEDICARE: WEST BROAD DENTAL PARTNERS LLP
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry
2261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1881208874
Entity Type Code : Organization
Provider Name (Legal Business Name) : WEST BROAD DENTAL PARTNERS LLP
Provider Business Mailing Address
First Line : 4089 W BROAD ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43228-1614
Country : US
Telephone Number : 614-954-0700
Fax Number : 614-954-0700
Provider Business Practice Location Address
First Line : 4089 W BROAD ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43228-1614
Country : US
Telephone Number : 614-954-0700
Fax Number : 614-954-0700
Authorized Official
Title or Position : OWNER
Name : BRANDON CANFIELD
Credential : DDS
Telephone Number : 614-954-0700
Provider Enumeration Date : 09/07/2020
Last Update Date : 09/07/2020

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Directions to “WEST BROAD DENTAL PARTNERS LLP ” Practice Location

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