Organization
BROADWAY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK BROWN DDS (DENTIST)
(516) 643-0424
Entity
Organization
Contact information
Practice address
48 E KINGSBRIDGE RD, BRONX, NY 10468-7514
(718) 933-9603
Mailing address
48 E KINGSBRIDGE RD, BRONX, NY 10468-7514
(718) 933-9603
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
054002
NY
Other
Enumeration date
06/18/2015
Last updated
06/18/2015
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