| Broadway Mall Dental | |
|
200 Broadway Mall Hicksville NY 11801 | |
| (516) 933-3444 | |
| (516) 933-3445 |
| Full Name | Broadway Mall Dental |
|---|---|
| Speciality | Dentist |
| Location | 200 Broadway Mall, Hicksville, New York |
| Authorized Official Name and Position | Igor Levin (OWNER) |
| Authorized Official Contact | 5169333444 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Broadway Mall Dental 200 Broadway Mall Hicksville NY 11801 Ph: (516) 933-3444 | Broadway Mall Dental 200 Broadway Mall Hicksville NY 11801 Ph: (516) 933-3444 |
| NPI Number | 1225183551 |
|---|---|
| Provider Enumeration Date | 01/25/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225183551 | NPI | - | NPPES |
| 02757968 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (New York) | Primary |
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