BROADWAY DENTAL SERVICES (NPI# 1215219084) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215219084 |
| Entity Type | Organization |
| Organization Name | BROADWAY DENTAL SERVICES |
| Practice Address |
3195 Broadway Gary IN 46409-1006 |
| Mailing Address |
1693 Stillwater Ave Dyer IN 46311-3088 |
| Practice Telephone | 2196713754 |
| Mailing Telephone | 2196713754 |
| Enumeration Date | 2011-09-16 |
| Last Update Date | 2011-09-16 |
| Authorized Official Name | DR. MUKUKA KAPILIKISHA (OWNER) |
| Authorized Official Telephone | 2196713754 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
12011216A | IN | Dental Providers |
| Street Address |
3195 BROADWAY |
| City | GARY |
| State | IN |
| Zip Code | 46409-1006 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750303343 | Adolphus A Anekwe | Specialist | 3195 Broadway, Gary, IN 46409-1006 | 2006-07-24 |
| 1528392156 | Tonya A. Harvey | Nurse Practitioner | 3195 Broadway, Gary, IN 46409-1006 | 2009-09-29 |
| 1629196761 | Broadway Medical Corporation, PC | Specialist | 3195 Broadway, Gary, IN 46409-1006 | 2007-03-27 |
| 1023166758 | Frank Edward Pate | Dentist | 3195 Broadway, Gary, IN 46409-1006 | 2007-01-08 |
| 1528173853 | Edwin Kenneth Mcdonald IIi | Dentist | 3195 Broadway, Gary, IN 46409-1006 | 2006-08-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316027998 | Nhi Home Base Service Corp. | Clinic/Center | 4795 Broadway, Gary, IN 46409 | 2006-10-17 |
| 1164891404 | Megan Burgess | Counselor | 4795 Broadway, Gary, IN 46409 | 2015-09-16 |
| 1366677213 | Merideth Krashonda Owens | Counselor | 4795 Broadway, Gary, IN 46409 | 2009-05-21 |
| 1548530439 | Sibis Counseling Center LLC | Counselor | 3195 Broadway Lowr Level, Gary, IN 46409-1006 | 2012-01-09 |
| 1063417657 | Raied Abdullah | Internal Medicine | 3229 Broadway, Suite 205, Gary, IN 46409-1036 | 2005-06-20 |
| 1184001851 | Accelerated Rehabilitation Centers, Ltd | Physical Therapist | 3229 Broadway, 112, Gary, IN 46409-1036 | 2015-05-01 |
| 1598922510 | Cardiovascular Clinics PC | Internal Medicine | 3229 Broadway, Gary, IN 46409-1036 | 2008-05-19 |
| 1548310873 | Ellan L Hood | Clinical Nurse Specialist | 3229 Broadway, Suite 205, Gary, IN 46409-1036 | 2007-01-11 |
| 1407946296 | Grace Garcia | Physical Therapist | 3229 Broadway, Gary, IN 46409-1036 | 2006-10-13 |
| 1912907288 | George D Smalls | Urology | 3229 Broadway, Suite 153, Gary, IN 46409-1036 | 2005-07-28 |
| Find all providers in zip 46409 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003172008 | Healthy Smiles Nwi | Dentist | 4629 Melton Rd., Gary, IN 46403 | 2012-04-04 |
| 1366674541 | Veronica Marie Brown | Dentist | Rt. 103 Supply Street, Gary, WV 24836 | 2009-08-20 |
| 1023201175 | Radcliffe Family Dental, LLC | Dentist | 1901 Grant Street, Gary, IN 46404-2761 | 2007-08-22 |
| 1356564512 | Wyatt L Smith | Dentist | 5010 Broadway, Gary, IN 46408-4606 | 2007-04-10 |
| 1912030826 | Trinoda G Radcliffe | Dentist | 1901 Grant St, Gary, IN 46404-2761 | 2007-03-13 |
| 1073684247 | Gary Smiles Youth Dentistry, LLC | Dentist | 3506 Village Ct, Gary, IN 46408-1428 | 2006-11-10 |
| 1992887392 | John W Balaban | Dentist | Route 103, Supply St, Gary, WV 24836 | 2006-10-19 |
| 1962500298 | Lynn E Gassoway | Dentist | 8412 Maple Ave, Gary, IN 46403 | 2006-09-20 |
| 1154934446 | Charmi Solanki | Dentist | 1021 W 5th Ave, Gary, IN 46402-1703 | 2020-08-26 |
| 1669901690 | Hye Sung Kim | Dentist | 1320 Broadway, Gary, IN 46407-1309 | 2017-06-04 |
| Find all providers in GARY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.