| NPI | 1427417328 |
|---|---|
| Doing Business As | BROADWAY SMILES |
| Entity Type | Organization |
| Authorized Contact | MARLENE THOMPSON Owner 760-480-5622 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 50382) |
| Enumeration Date | 2016-02-19 |
| Last Update Date | 2016-02-19 |