Broadway Smiles PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

26239 Issued in TX

Legal business name

BROADWAY SMILES PC

Practice address

1707 S Broadway St
Suite 10
Sulphur Springs, TX 75482-4960

Phone

(703) 338-9736

NPI assigned

Sep 14, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Praveena Seetharam Shetty, DMD

Title

Owner

Phone

(703) 338-9736

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1347580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347580800000",
    "number": "1194075341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1707 S BROADWAY ST",
            "address_2": "SUITE 10",
            "city": "SULPHUR SPRINGS",
            "state": "TX",
            "postal_code": "754824960",
            "telephone_number": "703-338-9736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 S BROADWAY ST",
            "address_2": "SUITE 10",
            "city": "SULPHUR SPRINGS",
            "state": "TX",
            "postal_code": "754824960",
            "telephone_number": "703-338-9736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY SMILES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-14",
        "last_updated": "2012-09-14",
        "status": "A",
        "authorized_official_last_name": "SHETTY",
        "authorized_official_first_name": "PRAVEENA",
        "authorized_official_middle_name": "SEETHARAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-338-9736",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "26239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2012; 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.