Organization
BROADWAY DENTAL, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMAD ARIF DDS (PRESIDENT)
(951) 642-0948
Entity
Organization
Contact information
Practice address
5621 S BROADWAY AVE, TYLER, TX 75703-4348
(951) 642-0948
Mailing address
5621 S BROADWAY AVE, TYLER, TX 75703-4348
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
29244
TX
Other
Enumeration date
08/02/2016
Last updated
08/02/2016
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