Organization
BROADWAY DENTISTRY, PC
Active
Organization
BROADWAY DENTISTRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MELISSA E KENFIELD DDS (OWNER)
(219) 769-1485
Entity
Organization
Contact information
Practice address
9247 BROADWAY, SUITE C, MERRILLVILLE, IN 46410-7018
(219) 769-1485
(219) 769-1493
Mailing address
9247 BROADWAY, SUITE C, MERRILLVILLE, IN 46410-7018
(219) 769-1485
(219) 769-1493
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12011101A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12011101A
IN STATE DENTAL LICENSE
IN
Enumeration date
11/25/2008
Last updated
11/25/2008
Update your record
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