Provider Demographics
NPI:1679372478
Name:FOX CREEK FAMILY DENTAL BROOMFIELD LLC
Entity type:Organization
Organization Name:FOX CREEK FAMILY DENTAL BROOMFIELD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE MANAGEMEN
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDUNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-331-8371
Mailing Address - Street 1:7995 E PRENTICE AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2713
Mailing Address - Country:US
Mailing Address - Phone:307-331-8371
Mailing Address - Fax:
Practice Address - Street 1:2055 W 136TH AVE STE 136
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-9308
Practice Address - Country:US
Practice Address - Phone:303-586-6846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESPIRE DENTAL HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty