Provider Demographics
NPI:1316396732
Name:BROADWAY DENTAL CARE, PLLC
Entity type:Organization
Organization Name:BROADWAY DENTAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SLAUGHTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-443-9099
Mailing Address - Street 1:2018 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7108
Mailing Address - Country:US
Mailing Address - Phone:270-443-9099
Mailing Address - Fax:270-443-9052
Practice Address - Street 1:2018 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7108
Practice Address - Country:US
Practice Address - Phone:270-443-9099
Practice Address - Fax:270-443-9052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty