Individual provider Active NPI

Alexander Brodeur, DMD

  • General Practice Dentistry
  • Loveland, CO
National Provider Identifier
1700246741
Registry record updated Oct 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
203729 Issued in CO
Practice address
302 3Rd St SE Ste 150
Loveland, CO 80537-6419
Phone
(970) 461-8942
Fax
(970) 292-1538
NPI assigned
Mar 3, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
General Practice Dentistry 1223G0001X 203729 CO Primary

Addresses

Primary practice location

302 3Rd St SE Ste 150
Loveland, CO 80537-6419

Mailing address

2930 11TH Ave
Evans, CO 80620-1011
Phone (970) 350-4606

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1456963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538438400000",
    "number": "1700246741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2930 11TH AVE",
            "city": "EVANS",
            "state": "CO",
            "postal_code": "806201011",
            "telephone_number": "970-350-4606",
            "fax_number": "970-350-4645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 3RD ST SE STE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805376419",
            "telephone_number": "970-461-8942",
            "fax_number": "970-292-1538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODEUR",
        "first_name": "ALEXANDER",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-03",
        "last_updated": "2018-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "203729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loveland, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2018; 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.