BROADWAY DENTAL SERVICES NPI 1215219084

NPI Information

  • NPI: 1215219084
  • Provider Name: BROADWAY DENTAL SERVICES
  • Classification: Dentist - 1223G0001X
  • Specialization: General Practice
  • Entity Type: Organization
  • Address: 3195 BROADWAY
    GARY, IN
    ZIP 46409
  • Phone: (219) 671-3754

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NPI Details

BROADWAY DENTAL SERVICES is a general practice dentist in Gary, IN. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. BROADWAY DENTAL SERVICES NPI is 1215219084. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3195 BROADWAY
GARY, IN
ZIP 46409-006
Phone: (219) 671-3754

The provider's authorized official is Mukuka Kapilikisha .
The authorized official title is Owner and has the following contact phone number (219) 671-3754.

The enumeration date for this NPI number is 9/16/2011 and was last updated on 9/16/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223G0001XDentistGeneral Practice12011216AINDIANAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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