NPIMap

Organization Active NPI

Broadmoor Valley Dental Services, P.C.

  • General Practice Dentistry
  • Colorado Springs, CO
National Provider Identifier
1740594043
Registry record updated Jul 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
9295 Issued in CO
Legal business name
BROADMOOR VALLEY DENTAL SERVICES, P.C.
Practice address
2965 Broadmoor Valley Rd
Colorado Springs, CO 80906-4407
Phone
(719) 632-7636
Fax
(719) 632-5134
NPI assigned
Jul 29, 2010
Last updated
Jul 29, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2010

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

Authorized official

Name
Dr. Oliver Moritz Spaeth, D.D.S.NPI 1962598870
Title
President
Phone
(719) 632-7636

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 9295 CO Primary

Addresses

Primary practice location

2965 Broadmoor Valley Rd
Colorado Springs, CO 80906-4407

Mailing address

2965 Broadmoor Valley Rd
Colorado Springs, CO 80906-4407
Phone (719) 632-7636

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1280361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280361600000",
    "number": "1740594043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2965 BROADMOOR VALLEY RD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809064407",
            "telephone_number": "719-632-7636",
            "fax_number": "719-632-5134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2965 BROADMOOR VALLEY RD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809064407",
            "telephone_number": "719-632-7636",
            "fax_number": "719-632-5134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADMOOR VALLEY DENTAL SERVICES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-29",
        "last_updated": "2010-07-29",
        "status": "A",
        "authorized_official_last_name": "SPAETH",
        "authorized_official_first_name": "OLIVER",
        "authorized_official_middle_name": "MORITZ",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "719-632-7636",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "9295",
            "primary": true
        }
    ],
    "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 Jul 29, 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.