Organization
BROADWAY SMILES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRAVEENA SEETHARAM SHETTY DMD (OWNER)
(703) 338-9736
Entity
Organization
Contact information
Practice address
1707 S BROADWAY ST, SUITE 10, SULPHUR SPRINGS, TX 75482-4960
(703) 338-9736
Mailing address
1707 S BROADWAY ST, SUITE 10, SULPHUR SPRINGS, TX 75482-4960
(703) 338-9736
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
26239
TX
Other
Enumeration date
09/14/2012
Last updated
09/14/2012
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