NPIMap

Organization Active NPI

Broadway Dental Services

  • General Practice Dentistry
  • Gary, IN
National Provider Identifier
1215219084
Registry record updated Sep 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12011216A Issued in IN
Legal business name
BROADWAY DENTAL SERVICES
Practice address
3195 Broadway
Gary, IN 46409-1006
Phone
(219) 671-3754
NPI assigned
Sep 16, 2011
Last updated
Sep 16, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2011

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

Authorized official

Name
Dr. Mukuka Kapilikisha, DMD
Title
Owner
Phone
(219) 671-3754

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 12011216A IN Primary

Addresses

Primary practice location

3195 Broadway
Gary, IN 46409-1006

Mailing address

1693 Stillwater Ave
Dyer, IN 46311-3088
Phone (219) 671-3754

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1316131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316131200000",
    "number": "1215219084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1693 STILLWATER AVE",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463113088",
            "telephone_number": "219-671-3754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3195 BROADWAY",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464091006",
            "telephone_number": "219-671-3754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY DENTAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-16",
        "last_updated": "2011-09-16",
        "status": "A",
        "authorized_official_last_name": "KAPILIKISHA",
        "authorized_official_first_name": "MUKUKA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "219-671-3754",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12011216A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gary, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2011; 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.