Dentists of Broadmoor, LLP

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

DENTISTS OF BROADMOOR, LLP

Doing business as

Dentists of Broadmoor

Practice address

160 East Cheyenne Road
Suite 120
Colorado Springs, CO 80906

Phone

(719) 249-8775

NPI assigned

Dec 30, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Janica J Gillette-Backstrom, DDS

Title

Owner

Phone

(719) 249-8775

Specialties & licenses 1

Addresses

Other names 1

• Dentists of Broadmoor Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1640822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640822400000",
    "number": "1164182242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "714-845-8890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 EAST CHEYENNE ROAD",
            "address_2": "SUITE 120",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80906",
            "telephone_number": "719-249-8775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTISTS OF BROADMOOR, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-30",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-29",
        "status": "A",
        "authorized_official_last_name": "GILLETTE-BACKSTROM",
        "authorized_official_first_name": "JANICA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-249-8775",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dentists of Broadmoor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.