BROADWAY DENTIST LLC (NPI# 1235381302) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235381302 |
| Entity Type | Organization |
| Organization Name | BROADWAY DENTIST LLC |
| Practice Address |
609 Broadway Everett MA 02149-3712 |
| Practice Telephone | 6173893636 |
| Mailing Telephone | 6173893636 |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2008-10-21 |
| Authorized Official Name | PETER ITKES (MANAGER) |
| Authorized Official Telephone | 6176941614 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
21366 | MA | Ambulatory Health Care Facilities |
| Street Address |
609 BROADWAY |
| City | EVERETT |
| State | MA |
| Zip Code | 02149-3712 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295336550 | Berthonya Joas | Physical Therapy Assistant | 62 Lawrence St, Everett, MA 02149 | 2020-11-03 |
| 1053940031 | Sarah Ann Bottiglio | Pharmacist | Whidden Hospital, 103 Garland Street, Everett, MA 02149 | 2020-04-02 |
| 1417494139 | Tsering Dolkar | Registered Nurse | Department of Surgery 103 Garland Street, Everett Hospital, Everett, MA 02149 | 2017-01-20 |
| 1073060190 | Egenie Desir | Registered Nurse | 102 Edith St, Everett, MA 02149 | 2016-09-07 |
| 1295113215 | Tracy Guan | Speech-Language Pathologist | 213 Springvale Ave, Everett, MA 02149 | 2015-05-11 |
| 1386075562 | Maritza Andrea Romano | Licensed Practical Nurse | 77 Clark Street, Everett, MA 02149 | 2013-12-12 |
| 1619221454 | Nicole Marie Shanahan | Social Worker | 23 Union Street, Apartment 2, Everett, MA 02149 | 2012-11-01 |
| 1760764997 | Ashish Agarwal | Pharmacist | 317 Ferry Street, Everett, MA 02149 | 2011-09-14 |
| 1851684856 | Jocelyn Ronda | Internal Medicine | Mgh Everett Family Care, 19 Norwood St, Everett, MA 02149 | 2011-05-24 |
| 1720292204 | Geraldine Chandra Martin | Optometrist | 2 Mystic View Road, Everett, MA 02149 | 2007-05-10 |
| Find all providers in zip 02149 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770130890 | Kcpp Community Outreach | Clinic/Center | 10121 Evergreen Way Ste 25-244, Everett, WA 98204-3885 | 2019-08-22 |
| 1386207579 | Alyssa Burns Dds, Pllc | Clinic/Center | 9801 27th Ave W, Everett, WA 98204-5057 | 2019-04-15 |
| 1891259081 | Bond Bond Pllc | Clinic/Center | 4608 Dogwood Dr Ste A, Everett, WA 98203-2000 | 2019-01-22 |
| 1063922938 | Kevin La, Pllc | Clinic/Center | 4809 132nd St Se Ste A105, Everett, WA 98208-6241 | 2017-10-05 |
| 1174051346 | Pro Brite Dental | Clinic/Center | 948 Broadway, Everett, MA 02149-3128 | 2017-05-31 |
| 1518413327 | Joseph Madson Dmd Pllc | Clinic/Center | 3802 Colby Ave, 4th Floor, Everett, WA 98201 | 2016-08-31 |
| 1003286477 | William Webley Dds Pllc | Clinic/Center | 11802 Evergreen Way, Suite 104, Everett, WA 98204-4620 | 2015-09-29 |
| 1467877027 | Thomas R Montenero D.m.d.p.c. | Clinic/Center | 80 Chelsea St, Everett, MA 02149-3530 | 2014-02-19 |
| 1285944991 | Pacific Northwest Dental | Clinic/Center | 4367 Rucker Avenue, Everett, WA 98203 | 2010-10-15 |
| 1336772698 | Kim Trieu, Dds, Pllc | Clinic/Center | 2032 Colby Ave, Everett, WA 98201-2234 | 2020-02-14 |
| Find all providers in EVERETT | ||||
Please comment or provide details below to improve the information on BROADWAY DENTIST LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.