Derrick Maurice Broadaway, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401007977 Issued in VA

Practice address

3709 Kecoughtan Rd
Hampton, VA 23669-4405

Phone

(757) 722-8507

Fax

(757) 690-8765

NPI assigned

Jan 18, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hampton Roads Family Dental

  • General Practice Dentistry
  • Hampton, VA
  • NPI 1932735305
  NPD
• Derrick M. Broadaway, D.D.S., PC

  • General Practice Dentistry
  • Virginia Beach, VA
  • NPI 1316156102
  NPD (past)

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1336292952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3709 KECOUGHTAN RD",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236694405",
            "telephone_number": "757-722-8507",
            "fax_number": "757-690-8765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3709 KECOUGHTAN RD",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236694405",
            "telephone_number": "757-722-8507",
            "fax_number": "757-690-8765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADAWAY",
        "first_name": "DERRICK",
        "middle_name": "MAURICE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2023-11-27",
        "certification_date": "2020-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401007977",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106546",
            "state": "VI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "mail@hrfdental.com",
            "affiliation": "Y",
            "endpointDescription": "Office",
            "address_1": "3709 Kecoughtan Rd",
            "city": "Hampton",
            "state": "VA",
            "country_code": "US",
            "postal_code": "236694405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brighterpaths Healthcare LLC
• Joseph Sam Brinda Jr., LMSW
• Brandi M Brinkman
• Gregory W Briscoe, M.D.
• Nefertari J Britto, MA, LPC, NCC
• Tashiko Lynn Bradshaw Broadhead, LMSW
• Broadus International Group Network, LLC
• Katesha Shanee Broadus, LCSW, BC-TMH
• Mandi Leigh Payne Brock, M.D.
• Laurel Olivia Brockenberry, PHD

• General Practice Dentistry in Hampton, VA
• Providers in Hampton, 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 Nov 27, 2023; 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.