Organization
BROADWAY GENTLE DENTISTRY PC
Active
Other names
Be Gentle Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD T MAMARIL DDS (PRESIDENT)
(765) 453-9389
Entity
Organization
Contact information
Practice address
2302 S DIXON RD STE 125, KOKOMO, IN 46902-6425
(765) 453-9389
(765) 453-9369
Mailing address
2302 S DIXON RD STE 125, KOKOMO, IN 46902-6425
(765) 453-9389
(765) 453-9369
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
54001486A
IN
Other
Enumeration date
11/06/2006
Last updated
10/06/2014
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