Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Broadmoor Lake Dental

Organization Dentist · NPI 1801286919

Broadmoor Lake Dental is a Dentist in Colorado Springs, Colorado. Licensed in Colorado. Registered with an NPI since 2015.

Licensed in
CO
In the registry since
2015

Practice location Address checks out

155 Lake Ave Ste 201
Colorado Springs, CO 80906-3717
Phone: (719) 375-5201
Fax: (844) 656-9696
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence 104909 (CO)

Record details

NPI number1801286919
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Marc Van Ness — Owner · (719) 375-5201
NPI enumeratedJanuary 27, 2015
Last updated in NPPESJuly 21, 2021
Certification dateJune 30, 2021
Mailing address155 Lake Ave Ste 201, Colorado Springs, CO 80906-3717

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