On Broadway Dentistry

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ON BROADWAY DENTISTRY

Practice address

4435 E Broadway Rd # 9
Mesa, AZ 85206-2012

Phone

(480) 223-0255

Fax

(480) 654-0705

NPI assigned

Feb 12, 2019

Organization subpart

No

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

Authorized official

Name

Bennett Mankin

Title

Ceo

Phone

(480) 636-0170

Specialties & licenses 3

Addresses

Locations

Practitioners 1

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

• Lindsay M Goss, D.M.D., M.P.H.

  • Dentist
  • Chandler, AZ
  • NPI 1902196371

  General Practice

  NPD (past)

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

{
    "created_epoch": "1549929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581033600000",
    "number": "1851857064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3658 E MORRISON RANCH PKWY",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852961816",
            "telephone_number": "480-636-0170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4435 E BROADWAY RD # 9",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852062012",
            "telephone_number": "480-223-0255",
            "fax_number": "480-654-0705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ON BROADWAY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-12",
        "last_updated": "2020-02-07",
        "certification_date": "2020-02-07",
        "status": "A",
        "authorized_official_last_name": "MANKIN",
        "authorized_official_first_name": "BENNETT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-636-0170"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Mesa, AZ
• Providers in Mesa, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2020; 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.