| Derrick M. Broadaway, D.D.S., PC | |
|
3809 Princess Anne Rd Suite 111 Virginia Beach VA 23456-1900 | |
| (757) 471-6672 | |
| Not Available |
| Full Name | Derrick M. Broadaway, D.D.S., PC |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3809 Princess Anne Rd, Virginia Beach, Virginia |
| Authorized Official Name and Position | Joyce S Davis (OFFICE MANAGER) |
| Authorized Official Contact | 7574716672 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Derrick M. Broadaway, D.D.S., PC 3809 Princess Anne Rd Suite 111 Virginia Beach VA 23456-1900 Ph: (757) 471-6672 | Derrick M. Broadaway, D.D.S., PC 3809 Princess Anne Rd Suite 111 Virginia Beach VA 23456-1900 Ph: (757) 471-6672 |
| NPI Number | 1316156102 |
|---|---|
| Provider Enumeration Date | 05/21/2007 |
| Last Update Date | 04/07/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316156102 | NPI | - | NPPES |
| 619881 | Other | VA | UNITED CONCORDIA PROVIDER |
| 106546 | Medicaid | VA | |
| 219275 | Other | VA | BLUE CROSS PROVIDER # |
| 000000005259 | Other | VA | DENTAL BENEFITS PROVIDER# |
| 000000005259 | Other | VA | UNITED HEALTHCARE PROVIDE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (Virginia) | Primary |
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