Provider Demographics
NPI:1376580423
Name:BROADWAY DENTAL CARE
Entity Type:Organization
Organization Name:BROADWAY DENTAL CARE
Other - Org Name:EDWARD G SUTTER DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:SUTTER
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-323-7727
Mailing Address - Street 1:1534 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-3811
Mailing Address - Country:US
Mailing Address - Phone:206-323-7727
Mailing Address - Fax:206-323-0733
Practice Address - Street 1:1534 BROADWAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-3811
Practice Address - Country:US
Practice Address - Phone:206-323-7727
Practice Address - Fax:206-323-0733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA28911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty