Organization
BROADWAY DENTAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FARAJOLLAH SOLEIMANZADEH DMD (PRESIDENT)
(516) 476-4509
Entity
Organization
Contact information
Practice address
7410 BROADWAY, ELMHURST, NY 11373-5609
(516) 476-4509
Mailing address
15 WOODFIELD LN, GLEN HEAD, NY 11545-2242
(516) 476-4509
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
124Q00000X
Dental Hygienist
—
—
Other
Enumeration date
09/07/2022
Last updated
09/07/2022
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