| Broadway Dental Services | |
|
3195 Broadway Gary IN 46409-1006 | |
| (219) 671-3754 | |
| Not Available |
| Full Name | Broadway Dental Services |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3195 Broadway, Gary, Indiana |
| Authorized Official Name and Position | Mukuka Kapilikisha (OWNER) |
| Authorized Official Contact | 2196713754 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Broadway Dental Services 1693 Stillwater Ave Dyer IN 46311-3088 Ph: (219) 671-3754 | Broadway Dental Services 3195 Broadway Gary IN 46409-1006 Ph: (219) 671-3754 |
| NPI Number | 1215219084 |
|---|---|
| Provider Enumeration Date | 09/16/2011 |
| Last Update Date | 09/16/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215219084 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 12011216A (Indiana) | Primary |
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