Provider Demographics
NPI:1881169472
Name:BROADVIEW DENTISTRY LLC
Entity type:Organization
Organization Name:BROADVIEW DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAJDI
Authorized Official - Middle Name:I
Authorized Official - Last Name:ALRABADY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-526-1000
Mailing Address - Street 1:9341 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-2305
Mailing Address - Country:US
Mailing Address - Phone:440-526-1000
Mailing Address - Fax:
Practice Address - Street 1:9341 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2305
Practice Address - Country:US
Practice Address - Phone:440-526-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty