Derrick M. Broadaway, D.D.S., PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DERRICK M. BROADAWAY, D.D.S., PC

Practice address

3809 Princess Anne Rd
Suite 111
Virginia Beach, VA 23456-1900

Phone

(757) 471-6672

NPI assigned

May 21, 2007

Organization subpart

Yes

Parent organization

DERRICK M. BROADAWAY, D.D.S., PCAs reported in NPPES

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

Authorized official

Name

Ms. Joyce S Davis, CDPMA

Title

Office Manager

Phone

(757) 471-6672

Specialties & licenses 1

Addresses

Other identifiers 5

Tax ID family

Derrick M Broadaway DDS PC2 organizations share this tax ID, including this one

Part of

Derrick M Broadaway DDS PC

Other organizations with this tax ID 1

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

• Derrick M. Broadaway, D.D.S., PC

  • General Practice Dentistry
  • Chesapeake, VA
  • NPI 1922218684
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Derrick M. Broadaway, D.D.S., PC

  • General Practice Dentistry
  • Chesapeake, VA
  • NPI 1922218684
  NPPES parent name

Practitioners 2

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

• Derrick Maurice Broadaway, DDS

  • General Practice Dentistry
  • Hampton, VA
  • NPI 1336292952
  NPD (past)
• Mark James Wuchner, D.D.S.

  • Dentist
  • Virginia Beach, VA
  • NPI 1144408329
  NPD (past)

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207526400000",
    "number": "1316156102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3809 PRINCESS ANNE RD",
            "address_2": "SUITE 111",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234561900",
            "telephone_number": "757-471-6672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3809 PRINCESS ANNE RD",
            "address_2": "SUITE 111",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234561900",
            "telephone_number": "757-471-6672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERRICK M. BROADAWAY, D.D.S., PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DERRICK M. BROADAWAY, D.D.S., PC",
        "enumeration_date": "2007-05-21",
        "last_updated": "2008-04-07",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JOYCE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "757-471-6672",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CDPMA"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE PROVIDE",
            "identifier": "000000005259",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA PROVIDER",
            "identifier": "619881",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER #",
            "identifier": "219275",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL BENEFITS PROVIDER#",
            "identifier": "000000005259",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106546",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dennis Lee Derbaum, LCSW CSAC
• Paul M Derber, M.D.
• Derek D. Russell, D.C., Inc.
• Jamie Lauren Dermatis, DPM
• Dermatology Inc. of Virginia Beach
• Michele Valenti Derwent
• Gautam D Desai, MD
• Saaransh Rakesh Desai, MD
• Heather Deschaine
• Suhas L Deshmukh, M.D.

• General Practice Dentistry in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 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.