Provider Demographics
NPI:1407270127
Name:BROADLANDS FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:BROADLANDS FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-460-8700
Mailing Address - Street 1:3800 W 144TH AVE UNIT 400
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-3991
Mailing Address - Country:US
Mailing Address - Phone:303-460-8700
Mailing Address - Fax:
Practice Address - Street 1:3800 W 144TH AVE UNIT 400
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-3991
Practice Address - Country:US
Practice Address - Phone:303-460-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty