| Broad Smile Dentistry | |
|
4017 Lauderdale Dr Henrico VA 23233-1082 | |
| (804) 913-1710 | |
| Not Available |
| Full Name | Broad Smile Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4017 Lauderdale Dr, Henrico, Virginia |
| Authorized Official Name and Position | Myungsuk Koh (OFFICER) |
| Authorized Official Contact | 8049131710 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Broad Smile Dentistry 4017 Lauderdale Dr Henrico VA 23233-1082 Ph: (804) 913-1710 | Broad Smile Dentistry 4017 Lauderdale Dr Henrico VA 23233-1082 Ph: (804) 913-1710 |
| NPI Number | 1770042723 |
|---|---|
| Provider Enumeration Date | 03/19/2019 |
| Last Update Date | 03/19/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770042723 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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