Broadway Dental PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

BROADWAY DENTAL PC

Practice address

743 Broadway
Bangor, ME 04401-3225

Phone

(207) 945-5300

NPI assigned

Sep 19, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Rebekah K Blanchette, DDS

Title

Owner

Phone

(207) 945-5300

Specialties & licenses 1

Addresses

Other identifiers 3

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rebekah L Blanchette, D.D.S.

  • General Practice Dentistry
  • Bangor, ME
  • NPI 1740591882
  NPD
• Brody Thomas Valley, DMD

  • Dentist
  • Bangor, ME
  • NPI 1679142988
  NPD
• John Edward Tozer, DMD

  • General Practice Dentistry
  • Bangor, ME
  • NPI 1871684282
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663545600000",
    "number": "1063134708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "743 BROADWAY",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013225",
            "telephone_number": "207-945-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "743 BROADWAY",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013225",
            "telephone_number": "207-945-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-19",
        "last_updated": "2022-09-19",
        "certification_date": "2022-09-19",
        "status": "A",
        "authorized_official_last_name": "BLANCHETTE",
        "authorized_official_first_name": "REBEKAH",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-945-5300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1-IND",
            "identifier": "1871684282",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1-IND",
            "identifier": "1679142988",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1-IND",
            "identifier": "1740591882",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bristol Hospice - Bangor, LLC
• Joseph Bruce Brittelli, RN
• Robin Brittelli, RPH
• Sandra Jeanne Britton, NP
• Michele Broadhurst, DC
• Sheryl A Brockett, LCPC C
• Amy S Brook, LCSW
• Nicole C Brooker, PT
• Robert L Brookings, D.M.D.
• Robert Thibeault Brookings

• All providers in Bangor, ME
• Dental Clinic/Center in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.