Provider Demographics
NPI:1568472694
Name:BROOMFIELD, ANGELA R (DDS)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:R
Last Name:BROOMFIELD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 E EMMA AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4469
Mailing Address - Country:US
Mailing Address - Phone:479-751-7417
Mailing Address - Fax:479-751-7304
Practice Address - Street 1:614 E EMMA AVE STE 300
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4469
Practice Address - Country:US
Practice Address - Phone:479-751-7417
Practice Address - Fax:479-751-7304
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR35711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice