# BROADWAY FAMILY DENTAL P.C.

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

## Provider details

- **NPI number:** 1457797318
- **Authorized official:** ANDREY IVANOV DDS (OWNER)
- **Authorized official phone:** 71804554400

## Contact information

- **Practice address:** 1152 BROADWAY, BROOKLYN, NY 11221-3002
- **Practice address phone:** (718) 455-4400
- **Mailing address:** 1152 BROADWAY, BROOKLYN, NY 11221-3002
- **Mailing address phone:** (718) 455-4400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/20/2013
- **Last updated:** 05/20/2013