Calen H. Broadbent, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00006273 Issued in WA

Practice address

17220 140TH Ave SE
Suite a
Renton, WA 98058-7000

Phone

(425) 226-4677

Fax

(425) 227-9029

NPI assigned

Jul 19, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1841219946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17220 140TH AVE SE",
            "address_2": "SUITE A",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980587000",
            "telephone_number": "425-226-4677",
            "fax_number": "425-227-9029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17220 140TH AVE SE",
            "address_2": "SUITE A",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980587000",
            "telephone_number": "425-226-4677",
            "fax_number": "425-227-9029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADBENT",
        "first_name": "CALEN",
        "middle_name": "H.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00006273",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5024971",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian Dansie, D.D.S.,M.S.,P.L.L.C.
• Derrick Bridges, LMP
• Brightconnections Care LLC
• Patricia Ann Briscoe, M.D.
• Jared Britcher, DPT
• Sarah Lynn Brockes
• Stephanie Nicole Brockmann
• Brook Angels Adult Family Home LLC
• Craig Brooker, M.D.
• Heather Brooke Hanson Broome, LMHC

• General Practice Dentistry in Renton, WA
• Providers in Renton, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.