Organization
BROADWAY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AYAN LAWSON DMD (DENTIST)
(918) 448-6083
Entity
Organization
Contact information
Practice address
2104 N BROADWAY ST, POTEAU, OK 74953-2501
(918) 647-7080
Mailing address
114 W MAIN ST, WILBURTON, OK 74578-4044
(918) 465-3535
(918) 465-3535
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5809
OK
Other
Enumeration date
03/16/2018
Last updated
03/16/2018
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