Michael William Broadbent, DMD, M.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

6511661-9924 Issued in UT

Practice address

3590 Harrison Blvd
Suite #2
Ogden, UT 84403-2060

Phone

(801) 392-7176

NPI assigned

May 7, 2007

Last updated

Apr 27, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective May 2, 2022 through May 2, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ut Oms Specialty Dental Services PLLC

  dba Burg Children's Dentistry & Orthodontics

  • Oral and Maxillofacial Surgery (Dentist)
  • West Jordan, UT
  • NPI 1194582031
  NPD (past)
• Ut Oms Specialty Dental Services PLLC

  dba Oral & Maxillofacial Surgeons of Utah

  • Oral and Maxillofacial Surgery (Dentist)
  • Layton, UT
  • NPI 1518724459
  NPD (past)

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430092800000",
    "number": "1205049459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3590 HARRISON BLVD",
            "address_2": "SUITE #2",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844032060",
            "telephone_number": "801-392-7176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3590 HARRISON BLVD",
            "address_2": "SUITE #2",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844032060",
            "telephone_number": "801-392-7176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADBENT",
        "first_name": "MICHAEL",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "DMD, M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-07",
        "last_updated": "2015-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "UT",
            "license": "6511661-9924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Brinkerhoff
• Kelly Jean Brinkerhoff, NURSE PRACTITIONER
• Bristol Hospice - Utah, L.L.C.
• Gary V Broadbent, LCSW
• Jeffrey P Broadbent, DMD
• Melanie Ann Broadhead
• Mark Steven Broccardo, COTA
• Raymond Donald Brock, CPSS
• Walter Evan Brodis, MD
• David E Brodstein, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Ogden, UT
• Providers in Ogden, UT by specialty
• Oral and Maxillofacial Surgery (Dentist) in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.