Provider Demographics
NPI:1205312469
Name:RETRO DENTAL BROOMFIELD DBD, LLC
Entity type:Organization
Organization Name:RETRO DENTAL BROOMFIELD DBD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF DENTAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-332-4949
Mailing Address - Street 1:5015 W 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5606
Mailing Address - Country:US
Mailing Address - Phone:303-466-2935
Mailing Address - Fax:
Practice Address - Street 1:5015 W 120TH AVE
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-5606
Practice Address - Country:US
Practice Address - Phone:303-466-2935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty