Broadmoor Valley Dental Care, PC

Primary specialty

DentistTaxonomy code 122300000X

License

9295 Issued in CO

Legal business name

BROADMOOR VALLEY DENTAL CARE, PC

Practice address

2965 Broadmoor Valley Rd
Colorado Springs, CO 80906-4407

Phone

(719) 632-7636

Fax

(719) 632-5134

NPI assigned

Jul 12, 2010

Last updated

Jul 12, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Oliver SpaethNPI 1962598870

Title

President

Phone

(719) 632-7636

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Oliver Spaeth, DDS

  • Dentist
  • Colorado Springs, CO
  • NPI 1962598870
  Authorized official Same address or phone

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

{
    "created_epoch": "1278892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278892800000",
    "number": "1902118508",
    "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 CARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-12",
        "last_updated": "2010-07-12",
        "status": "A",
        "authorized_official_last_name": "SPAETH",
        "authorized_official_first_name": "OLIVER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "719-632-7636"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "9295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOLE PROPRIETOR NPI NUMBER",
            "identifier": "1962598870",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Broadmoor Dental, LLC
• Broadmoor Hearing Clinic LLC
• Broadmoor Lake Dental
• Broadmoor PDC PLLC
• Broadmoor Psychological Services LLC
• Broadmoor Valley Dental PLLC
• Broadmoor Valley Dental Services, P.C.
• Broadmoor Valley Wellness Center, Inc.
• Brennan Broadway, AGACNP
• Malik Broady

• 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 12, 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.