Organization
BROADWAY FAMILY AND COSMETIC DENTISTRY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY A. SMITH D.D.S. (OWNER)
(712) 323-3615
Entity
Organization
Contact information
Practice address
2612 W BROADWAY, COUNCIL BLUFFS, IA 51501-3510
(712) 323-3615
(712) 325-6155
Mailing address
2612 W BROADWAY, COUNCIL BLUFFS, IA 51501-3510
(712) 323-3615
(712) 325-6155
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6699
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
039537
UNITED CONCORDIA
PA
01
—
18575
DELTA DENTAL OF IOWA
IA
01
—
5334
BLUE CROSS
NE
Enumeration date
03/08/2007
Last updated
08/01/2008
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