Organization
BROADWAY FAMILY DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER J PULLARA JR. D.D.S. (DENTIST/OWNER)
(815) 634-8009
Entity
Organization
Contact information
Practice address
595 N BROADWAY ST, COAL CITY, IL 60416-1046
(815) 634-8009
(815) 634-2008
Mailing address
595 N BROADWAY ST, COAL CITY, IL 60416-1046
(815) 634-8009
(815) 634-2008
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019021493
IL
Other
Enumeration date
01/06/2012
Last updated
01/06/2012
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