NPIMap

Organization Active NPI

Broadway Dentist LLC

  • Dental Clinic/Center
  • Everett, MA
National Provider Identifier
1235381302
Registry record updated Oct 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
21366 Issued in MA
Legal business name
BROADWAY DENTIST LLC
Practice address
609 Broadway
Everett, MA 02149-3712
Phone
(617) 389-3636
NPI assigned
Oct 21, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2008

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

Authorized official

Name
Peter Itkes
Title
Manager
Phone
(617) 694-1614

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 21366 MA Primary

Addresses

Primary practice location

609 Broadway
Everett, MA 02149-3712

Mailing address

609 Broadway
Everett, MA 02149-3712
Phone (617) 389-3636

National Provider Directory

National Provider Directory
Tax ID family
Winchester Family Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1224547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224547200000",
    "number": "1235381302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 BROADWAY",
            "city": "EVERETT",
            "state": "MA",
            "postal_code": "021493712",
            "telephone_number": "617-389-3636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 BROADWAY",
            "city": "EVERETT",
            "state": "MA",
            "postal_code": "021493712",
            "telephone_number": "617-389-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY DENTIST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-21",
        "last_updated": "2008-10-21",
        "status": "A",
        "authorized_official_last_name": "ITKES",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "617-694-1614"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MA",
            "license": "21366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2008; 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.