| NPI | 1710521752 |
|---|---|
| Doing Business As | THAT BROADWAY SMILE |
| Entity Type | Organization |
| Authorized Contact | HIRO SORIANO CIO 516-344-5746 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2019-11-02 |
| Last Update Date | 2019-11-02 |