Provider Demographics
NPI:1073646196
Name:BROUGHTON PRO INC.
Entity Type:Organization
Organization Name:BROUGHTON PRO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:BROUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-934-3651
Mailing Address - Street 1:981 STATE ROAD 46 E
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-7631
Mailing Address - Country:US
Mailing Address - Phone:812-934-3651
Mailing Address - Fax:812-932-0203
Practice Address - Street 1:981 STATE ROAD 46 E
Practice Address - Street 2:SUITE B
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-7631
Practice Address - Country:US
Practice Address - Phone:812-934-3651
Practice Address - Fax:812-932-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN7407A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty