NPIMap

Organization Active NPI

Broadway Family and Cosmetic Dentistry, Partnership

  • General Practice Dentistry
  • Council Bluffs, IA
National Provider Identifier
1063715969
Registry record updated Dec 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6699 Issued in IA
Legal business name
BROADWAY FAMILY AND COSMETIC DENTISTRY, PARTNERSHIP
Practice address
2612 W Broadway
Council Bluffs, IA 51501-3510
Phone
(712) 323-3615
Fax
(712) 325-6155
NPI assigned
Dec 15, 2010
Last updated
Dec 15, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2010

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

Authorized official

Name
Dr. Gary A Smith, DDSNPI 1063441384
Title
Dentist
Phone
(712) 323-3615

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 6699 IA Primary

Addresses

Primary practice location

2612 W Broadway
Council Bluffs, IA 51501-3510

Mailing address

2612 W Broadway
Council Bluffs, IA 51501-3510
Phone (712) 323-3615

National Provider Directory

National Provider Directory

Locations

2612 W Broadway
Council Bluffs, IA 51501
Phone (712) 323-3615

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1292371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292371200000",
    "number": "1063715969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2612 W BROADWAY",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515013510",
            "telephone_number": "712-323-3615",
            "fax_number": "712-325-6155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2612 W BROADWAY",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515013510",
            "telephone_number": "712-323-3615",
            "fax_number": "712-325-6155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY FAMILY AND COSMETIC DENTISTRY, PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-15",
        "last_updated": "2010-12-15",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "712-323-3615",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "6699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2010; 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.