Provider Demographics
NPI:1639537616
Name:BROADWAY FAMILY DENTAL PRESENTED BY DR. TARIQ SAYEGH BDS LLC
Entity Type:Organization
Organization Name:BROADWAY FAMILY DENTAL PRESENTED BY DR. TARIQ SAYEGH BDS LLC
Other - Org Name:BROADWAY FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:SAYEGH
Authorized Official - Last Name:SAYEGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:1440-454-3536
Mailing Address - Street 1:5716 BROADWAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44127-1715
Mailing Address - Country:US
Mailing Address - Phone:216-862-4990
Mailing Address - Fax:216-862-3585
Practice Address - Street 1:5716 BROADWAY AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127-1715
Practice Address - Country:US
Practice Address - Phone:216-862-4990
Practice Address - Fax:216-862-3585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2943391Medicaid