NPI 1215219084

Broadway Dental Services

Organisation General Practice Dentistry Gary, IN

Practice location

Address: 3195 Broadway, Gary, IN 46409-1006
Phone: (219) 671-3754
Mailing address: 1693 Stillwater Ave, Dyer, IN 46311-3088

Authorised official

Name: Mukuka Kapilikisha
Title: Owner
Phone: (219) 671-3754

Registered specialties

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X Licence 12011216A (IN)

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Registry record

NPI: 1215219084
Entity type: Organization
NPI issued: 16 Sep 2011
Record last updated: 16 Sep 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.