Broadway Gentle Dentistry PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

54001486A Issued in IN

Legal business name

BROADWAY GENTLE DENTISTRY PC

Doing business as

Be Gentle Dentistry

Practice address

2302 S Dixon Rd Ste 125
Kokomo, IN 46902-6425

Phone

(765) 453-9389

Fax

(765) 453-9369

NPI assigned

Nov 6, 2006

Organization subpart

No

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

Authorized official

Name

Edward T Mamaril, DDSNPI 1215095815

Title

President

Phone

(765) 453-9389

Specialties & licenses 1

Addresses

Other names 1

• Be Gentle Dentistry Doing business as

Practitioners 2

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

• Edward T Mamaril, DDS

  • General Practice Dentistry
  • Kokomo, IN
  • NPI 1215095815
  NPD (past) Authorized official
• Allison Nicole Gibson, D.D.S.

  • General Practice Dentistry
  • Kokomo, IN
  • NPI 1609214535
  NPD (past)

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412553600000",
    "number": "1437238607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2302 S DIXON RD STE 125",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469026425",
            "telephone_number": "765-453-9389",
            "fax_number": "765-453-9369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2302 S DIXON RD STE 125",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469026425",
            "telephone_number": "765-453-9389",
            "fax_number": "765-453-9369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY GENTLE DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2014-10-06",
        "status": "A",
        "authorized_official_last_name": "MAMARIL",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "765-453-9389",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "54001486A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Be Gentle Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Eric Daniel Breisch
• Jeffrey Nicholas Brentin, DO
• Rachel Bridges, FNP
• Emma Briggs
• Mackenzie Katherine Bristol
• Jill Brock
• Theodore W Brogan, MD
• Brookdale Senior Living Communities Inc (Sterling House of Kokomo)
• Cheyenne B Brooks, RBT
• Monica Brooks

• General Practice Dentistry in Kokomo, IN
• Providers in Kokomo, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2014; 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.