Individual
DR. DERRICK MAURICE BROADAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3709 KECOUGHTAN RD, HAMPTON, VA 23669-4405
(757) 722-8507
(757) 690-8765
Mailing address
3709 KECOUGHTAN RD, HAMPTON, VA 23669-4405
(757) 722-8507
(757) 690-8765
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401007977
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106546
—
VI
Enumeration date
01/18/2007
Last updated
11/27/2023
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