Michael Tyler Broadbent, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D008960 Issued in AZ

Practice address

1058 N Higley Rd
Suite 212
Mesa, AZ 85205-5399

Phone

(480) 924-8633

NPI assigned

Jun 10, 2014

Last updated

Jun 10, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Michael D Broadbent DDS PC

  • General Practice Dentistry
  • Mesa, AZ
  • NPI 1467631812
  NPD (past)
• Signature Arizona Dental Partners LLC

  dba Family Dentistry of Buckeye

  • Dental Clinic/Center
  • Tempe, AZ
  • NPI 1104395094
  NPD (past)

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

{
    "created_epoch": "1402358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402358400000",
    "number": "1710390448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9266 E KEATS AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852092523",
            "telephone_number": "480-789-2793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1058 N HIGLEY RD",
            "address_2": "SUITE 212",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852055399",
            "telephone_number": "480-924-8633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADBENT",
        "first_name": "MICHAEL",
        "middle_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-10",
        "last_updated": "2014-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D008960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maureen Patricia Bristow
• Alyssa Britland, LMT
• Krystynna J Britton
• Mary Ruth Brix, MS, PT
• Michael D Broadbent, DDS PC
• Broadway East Internists
• Caylie Brock, LAC
• Clint Brock
• Anissa Brockman, RPH
• Mary Louise Brockmeier, MT-BC

• General Practice Dentistry in Mesa, AZ
• Providers in Mesa, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2014; 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.