Broadmoor Srg Pllc

NPI #1831839455 in Mesquite, Texas

Provider Information

NPI Number: 1831839455
Entity Type: Organization
Organization Name: Broadmoor Srg Pllc
Primary Specialty: Dentist
Enumeration Date: Mar 31, 2022
Last Updated: Oct 12, 2022

Practice Location

Address: 500 N GALLOWAY AVE STE 6
City: Mesquite
State: Texas
ZIP Code: 75149-4338
Phone: (214) 493-1216

Authorized Official

Name: NINA ABTAHI
Title: MANAGER
Phone: (214) 493-1216

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X
Dentist	122300000X	Primary

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