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

3325 Taylor Rd
Suite 111
Chesapeake, VA 23321-3300

Phone

(757) 686-3033

NPI assigned

May 23, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Derrick M Broadaway, D.D.S.

Title

Practice Owner

Phone

(757) 686-3033

Specialties & licenses 1

Addresses

Other identifiers 4

Tax ID family

Derrick M Broadaway DDS PC2 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.

• Derrick M. Broadaway, D.D.S., PC

  • General Practice Dentistry
  • Virginia Beach, VA
  • NPI 1316156102
  NPD tax ID

Locations

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.

• Derrick M. Broadaway, D.D.S., PC

  • General Practice Dentistry
  • Virginia Beach, VA
  • NPI 1316156102
  NPPES parent name

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1922218684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3325 TAYLOR RD",
            "address_2": "SUITE 111",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233213300",
            "telephone_number": "757-686-3033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3325 TAYLOR RD",
            "address_2": "SUITE 111",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233213300",
            "telephone_number": "757-686-3033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERRICK M. BROADAWAY, D.D.S., PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROADAWAY",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRACTICE OWNER",
        "authorized_official_telephone_number": "757-686-3033",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL BENEFITS PROV#",
            "identifier": "000000005259",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005094",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE PROV#",
            "identifier": "000000005259",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONC PROV #",
            "identifier": "864302",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dental Professionals of Virginia, P.C.
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• Destiny Medical Transport
• Brittany Renee Deuso, PT, DPT

• General Practice Dentistry in Chesapeake, VA
• Providers in Chesapeake, 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 Aug 22, 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.