| Broadway Dentist Llc | |
|
609 Broadway Everett MA 02149-3712 | |
| (617) 389-3636 | |
| Not Available |
| Full Name | Broadway Dentist Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 609 Broadway, Everett, Massachusetts |
| Authorized Official Name and Position | Peter Itkes (MANAGER) |
| Authorized Official Contact | 6176941614 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Broadway Dentist Llc 609 Broadway Everett MA 02149-3712 Ph: (617) 389-3636 | Broadway Dentist Llc 609 Broadway Everett MA 02149-3712 Ph: (617) 389-3636 |
| NPI Number | 1235381302 |
|---|---|
| Provider Enumeration Date | 10/21/2008 |
| Last Update Date | 10/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235381302 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 21366 (Massachusetts) | Primary |
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