| Broadway Dental | |
|
82 West John Street Hicksville NY 11801 | |
| (516) 681-2525 | |
| (516) 681-3514 |
| Full Name | Broadway Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 82 West John Street, Hicksville, New York |
| Authorized Official Name and Position | Scott M Russ (OWNER DENTIST) |
| Authorized Official Contact | 5166812525 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Broadway Dental 82 West John Street Hicksville NY 11801 Ph: (516) 681-2525 | Broadway Dental 82 West John Street Hicksville NY 11801 Ph: (516) 681-2525 |
| NPI Number | 1902010895 |
|---|---|
| Provider Enumeration Date | 05/09/2007 |
| Last Update Date | 11/24/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902010895 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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