Organization
BROADMOOR PDC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK CHRISTENSEN (CREDENTIALING SPECIALIST)
(801) 305-3460
Entity
Organization
Contact information
Practice address
2965 BROADMOOR VALLEY RD, COLORADO SPRINGS, CO 80906-4407
(719) 632-7636
Mailing address
PO BOX 970354, OREM, UT 84097-0354
(801) 305-3460
(801) 335-6551
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/15/2023
Last updated
12/15/2023
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