| NPI | 1164182242 |
|---|---|
| Doing Business As | DENTISTS OF BROADMOOR |
| Entity Type | Organization |
| Authorized Contact | JANICA J GILLETTE-BACKSTROM Owner 719-249-8775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2021-12-30 |
| Last Update Date | 2021-12-30 |