| NPI | 1902010895 |
|---|---|
| Other Name | BROADWAY DENTAL |
| Entity Type | Organization |
| Authorized Contact | SCOTT M RUSS Owner Dentist 516-681-2525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2009-11-24 |