# MICHAEL D BROADBENT DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467631812
- **Authorized official:** MICHAEL D BROADBENT DDS (OWNER PRESIDENT DENTIST)
- **Authorized official phone:** (480) 924-8633

## Contact information

- **Practice address:** 1058 N HIGLEY RD, SUITE 212, MESA, AZ 85205
- **Practice address phone:** (480) 924-8633
- **Practice address fax:** (480) 924-2647
- **Mailing address:** 1058 N HIGLEY RD, SUITE 212, MESA, AZ 85205
- **Mailing address phone:** (480) 924-8633
- **Mailing address fax:** (480) 924-8633

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 3584 | AZ | Yes |

## Other

- **Enumeration date:** 11/01/2007
- **Last updated:** 11/01/2007