# BEVERLY BROADWELL DDS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073626875
- **Authorized official:** DR. BEVERLY B BROADWELL DDS PLLC (DENTIST OWNER)
- **Authorized official phone:** (704) 723-9252

## Contact information

- **Practice address:** 1921 CONCORD LAKE ROAD, KANNAPOLIS, NC 28083
- **Practice address phone:** (704) 723-9252
- **Practice address fax:** (704) 793-4531
- **Mailing address:** 1921 CONCORD LAKE ROAD, KANNAPOLIS, NC 28083
- **Mailing address phone:** (704) 723-9252
- **Mailing address fax:** (704) 793-4531

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 08/16/2006
- **Last updated:** 08/22/2020