Provider Demographics
NPI:1043425697
Name:BROADWAY DENTAL, P.C.
Entity Type:Organization
Organization Name:BROADWAY DENTAL, P.C.
Other - Org Name:DR. GOODMAN-CHERRIER, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:GOODMAN-CHERRIER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-249-1100
Mailing Address - Street 1:1301 NE BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1235
Mailing Address - Country:US
Mailing Address - Phone:503-249-1100
Mailing Address - Fax:503-249-2969
Practice Address - Street 1:1301 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1235
Practice Address - Country:US
Practice Address - Phone:503-249-1100
Practice Address - Fax:503-249-2969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD 5439261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental