NPIMap

Organization Active NPI

Broadmoor Dental, LLC

  • General Practice Dentistry
  • Colorado Springs, CO
National Provider Identifier
1295037646
Registry record updated Nov 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
8913 Issued in CO
Legal business name
BROADMOOR DENTAL, LLC
Practice address
1930 S Nevada Ave
Colorado Springs, CO 80905-3407
Phone
(719) 576-5566
Fax
(719) 576-1100
NPI assigned
Nov 17, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2010

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

Authorized official

Name
Dr. Nicolas Roger Pruett, D.D.S.NPI 1215034939
Title
Owner/Dentist
Phone
(719) 576-5566

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 8913 CO Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 9966 CO
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 9952 CO
Dental HygienistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 124Q00000X 905802 CO
Dental HygienistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 124Q00000X 905995 CO
Dental HygienistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 124Q00000X 906138 CO

Addresses

Primary practice location

1930 S Nevada Ave
Colorado Springs, CO 80905-3407

Mailing address

1930 S Nevada Ave
Colorado Springs, CO 80905-3407
Phone (719) 576-5566

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1289952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289952000000",
    "number": "1295037646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 S NEVADA AVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809053407",
            "telephone_number": "719-576-5566",
            "fax_number": "719-576-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 S NEVADA AVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809053407",
            "telephone_number": "719-576-5566",
            "fax_number": "719-576-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADMOOR DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-17",
        "last_updated": "2010-11-17",
        "status": "A",
        "authorized_official_last_name": "PRUETT",
        "authorized_official_first_name": "NICOLAS",
        "authorized_official_middle_name": "ROGER",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "719-576-5566",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "8913",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "9966",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "9952",
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": "CO",
            "license": "905802",
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": "CO",
            "license": "905995",
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": "CO",
            "license": "906138",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2010; 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.