Provider Demographics
NPI:1316707359
Name:BROOMFIELD PREMIER DENTISTRY, PC
Entity type:Organization
Organization Name:BROOMFIELD PREMIER DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:S
Authorized Official - Last Name:ITALIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-460-9366
Mailing Address - Street 1:899 HWY 287 STE 600
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-7319
Mailing Address - Country:US
Mailing Address - Phone:303-460-9366
Mailing Address - Fax:
Practice Address - Street 1:899 HWY 287 STE 600
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7319
Practice Address - Country:US
Practice Address - Phone:303-460-9366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental