| NPI | 1093456857 |
|---|---|
| Doing Business As | BROADMOOR DENTAL |
| Entity Type | Organization |
| Authorized Contact | HILLARY THULL Credentialing Coordinator 217-540-8946 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2022-04-05 |