Organization
BROADWAY FAMILY DENTAL P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREY IVANOV DDS (OWNER)
71804554400
Entity
Organization
Contact information
Practice address
1152 BROADWAY, BROOKLYN, NY 11221-3002
(718) 455-4400
Mailing address
1152 BROADWAY, BROOKLYN, NY 11221-3002
(718) 455-4400
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/20/2013
Last updated
05/20/2013
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