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General NPI Number Information
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NPI Number | 1518487990
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Entity Type | Organization
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Legal Business Name | BDC, LLC
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Dates
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Enumeration Date | 06/26/2017
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 7750 N UNION BLVD STE 101
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-4081
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Country | US
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Telephone | 719-598-1293
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Fax |
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Provider Business Mailing Address
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Address Line | 7750 N UNION BLVD STE 101
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-4081
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Country | US
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Telephone | 719-598-1293
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. THOMAS BAUMGARDNER JR.
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Credential | DMD
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Telephone | 719-598-1293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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