Broadmoor Lake Dental

Primary specialty

DentistTaxonomy code 122300000X

License

104909 Issued in CO

Legal business name

BROADMOOR LAKE DENTAL

Practice address

155 Lake Ave Ste 201
Colorado Springs, CO 80906-3717

Phone

(719) 375-5201

Fax

(844) 656-9696

NPI assigned

Jan 27, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Marc Van Ness, D.M.D.NPI 1689765968

Title

Owner

Phone

(719) 375-5201

Specialties & licenses 1

Addresses

Locations

Practitioners 3

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

• Marc Robert Vanness, D.M.D.

  • General Practice Dentistry
  • Colorado Springs, CO
  • NPI 1689765968
  NPD (past) Authorized official
• Steven George

  • General Practice Dentistry
  • Colorado Springs, CO
  • NPI 1750875019
  NPD (past)
• Benjamin Miettunen, DDS

  • Dentist
  • Colorado Springs, CO
  • NPI 1871116749
  NPD (past)

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

{
    "created_epoch": "1422316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626825600000",
    "number": "1801286919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 LAKE AVE STE 201",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809063717",
            "telephone_number": "719-375-5201",
            "fax_number": "844-656-9696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 LAKE AVE STE 201",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809063717",
            "telephone_number": "719-375-5201",
            "fax_number": "844-656-9696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADMOOR LAKE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-27",
        "last_updated": "2021-07-21",
        "certification_date": "2021-06-30",
        "status": "A",
        "authorized_official_last_name": "VAN NESS",
        "authorized_official_first_name": "MARC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-375-5201",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "104909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Lloyd Brlansky, OT
• Reed Bro, OD
• Broadmoor Bluffs Counseling
• Broadmoor Dental, LLC
• Broadmoor Hearing Clinic LLC
• Broadmoor PDC PLLC
• Broadmoor Psychological Services LLC
• Broadmoor Valley Dental Care, PC
• Broadmoor Valley Dental PLLC
• Broadmoor Valley Dental Services, P.C.

• Dentist in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; 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.