Provider Demographics
NPI:1417261371
Name:BROOKE LUNDY FLEISCHMANN, DDS, PC
Entity Type:Organization
Organization Name:BROOKE LUNDY FLEISCHMANN, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:LUNDY
Authorized Official - Last Name:FLEISCHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-887-0347
Mailing Address - Street 1:88 LAMAR ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2498
Mailing Address - Country:US
Mailing Address - Phone:303-466-7300
Mailing Address - Fax:303-466-0602
Practice Address - Street 1:88 LAMAR ST
Practice Address - Street 2:SUITE 108
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2498
Practice Address - Country:US
Practice Address - Phone:303-466-7300
Practice Address - Fax:303-466-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1811222482OtherINDIVIDUAL NPI