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General NPI Number Information
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NPI Number | 1336434661
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Entity Type | Individual
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Provider Name | JEFFREY P BROADBENT DMD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2011
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Last Update Date | 06/15/2011
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Provider Practice Location Address
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Address Line | 3590 HARRISON BLVD SUITE 5
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City | OGDEN
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State | UT
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Zip | 84403-2060
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Country | US
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Telephone | 801-621-1440
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Fax | 801-394-6833
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Provider Business Mailing Address
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Address Line | COLLEGE PARK PLAZA HARRISON 3590 SUITE 5
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City | OGDEN
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State | UT
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Zip | 84403
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Country | US
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Telephone | 801-621-1440
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Fax | 801-394-6833
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5329002-9922
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License Number State | UT
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