Derrick M. Broadaway, D.D.S., Pc
LBN: Derrick M. Broadaway, D.D.S., Pc
Derrick M. Broadaway, D.D.S., Pc is an health care organization with primary practice located at 3325 Taylor Rd Suite 111, Chesapeake VA 23321-3300. The organization recently has only one registered license in Dental Providers / General Practice, which is considered as the primary health care specialty.
Derrick M. Broadaway, D.D.S., Pc can be contacted via phone (757) 686-3033, or through Broadaway, Derrick M via phone (757) 686-3033.
Contact Information
Primary practice address
3325 Taylor Rd Suite 111
Chesapeake VA 23321-3300
Phone: (757) 686-3033
Fax:
Website:
Authorized official contact:
Name: Broadaway, Derrick M Doctor of Dental Surgery (DDS)
Phone: (757) 686-3033
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X |
Profile Details
| NPI number | 1922218684 |
|---|---|
| LBN Legal business name | Derrick M. Broadaway, D.D.S., Pc |
| DBA Doing business as | |
| Authorized official | Broadaway, Derrick M Doctor of Dental Surgery (DDS) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | May 23rd, 2007 |
| Last updated | Aug 22nd, 2020 - about 4 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1922218684 | NPPES |
| Virginia | Other | 000000005259 | DENTAL BENEFITS PROV# |
| Virginia | MEDICAID | 005094 | DENTAL BENEFITS PROV# |
| Virginia | Other | 000000005259 | DENTAL BENEFITS PROV# |
| Virginia | Other | 864302 | DENTAL BENEFITS PROV# |
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