# BROADWAY GENTLE DENTISTRY PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Be Gentle Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437238607
- **Authorized official:** EDWARD T MAMARIL DDS (PRESIDENT)
- **Authorized official phone:** (765) 453-9389

## Contact information

- **Practice address:** 2302 S DIXON RD STE 125, KOKOMO, IN 46902-6425
- **Practice address phone:** (765) 453-9389
- **Practice address fax:** (765) 453-9369
- **Mailing address:** 2302 S DIXON RD STE 125, KOKOMO, IN 46902-6425
- **Mailing address phone:** (765) 453-9389
- **Mailing address fax:** (765) 453-9369

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 54001486A | IN | Yes |

## Other

- **Enumeration date:** 11/06/2006
- **Last updated:** 10/06/2014