Provider Demographics
NPI:1982472361
Name:BROADWAY FAMILY DENTISTRY & IMPLANTS ,PLLC
Entity Type:Organization
Organization Name:BROADWAY FAMILY DENTISTRY & IMPLANTS ,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-290-2396
Mailing Address - Street 1:1573 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2607
Mailing Address - Country:US
Mailing Address - Phone:303-333-1844
Mailing Address - Fax:
Practice Address - Street 1:1573 S BROADWAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-2607
Practice Address - Country:US
Practice Address - Phone:303-333-1844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty