Organization
BROADMOOR VALLEY DENTAL CARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLIVER SPAETH (PRESIDENT)
(719) 632-7636
Entity
Organization
Contact information
Practice address
2965 BROADMOOR VALLEY RD, COLORADO SPRINGS, CO 80906-4407
(719) 632-7636
(719) 632-5134
Mailing address
2965 BROADMOOR VALLEY RD, COLORADO SPRINGS, CO 80906-4407
(719) 632-7636
(719) 632-5134
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9295
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1962598870
SOLE PROPRIETOR NPI NUMBER
CO
Enumeration date
07/12/2010
Last updated
07/12/2010
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