1811222482 NPI number — DR. BROOKE LUNDY FLEISCHMANN DDS

Table of content: DR. BROOKE LUNDY FLEISCHMANN DDS (NPI 1811222482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811222482 NPI number — DR. BROOKE LUNDY FLEISCHMANN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLEISCHMANN
Provider First Name:
BROOKE
Provider Middle Name:
LUNDY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LUNDY
Provider Other First Name:
BROOKE
Provider Other Middle Name:
HELEN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811222482
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1080 US HIGHWAY 287
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOMFIELD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80020-7004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-466-7300
Provider Business Mailing Address Fax Number:
303-469-9595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1080 US HIGHWAY 287
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOMFIELD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80020-7004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-466-7300
Provider Business Practice Location Address Fax Number:
303-469-9595
Provider Enumeration Date:
10/14/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  8458 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)