Provider Demographics
NPI:1215001052
Name:BROADWAY FAMILY DENTAL CARE LLC
Entity Type:Organization
Organization Name:BROADWAY FAMILY DENTAL CARE LLC
Other - Org Name:NORMAN D SAAGER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SAAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-938-3363
Mailing Address - Street 1:508 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MILTON FREEWATER
Mailing Address - State:OR
Mailing Address - Zip Code:97862
Mailing Address - Country:US
Mailing Address - Phone:541-938-3363
Mailing Address - Fax:541-938-3912
Practice Address - Street 1:508 E BROADWAY
Practice Address - Street 2:
Practice Address - City:MILTON FREEWATER
Practice Address - State:OR
Practice Address - Zip Code:97862
Practice Address - Country:US
Practice Address - Phone:541-938-3363
Practice Address - Fax:541-938-3912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD49731223G0001X
ORD81701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR6620600001Medicare NSC