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 |