Provider Demographics
NPI:1013209287
Name:BENCH, STEVEN RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RICHARD
Last Name:BENCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84629-0009
Mailing Address - Country:US
Mailing Address - Phone:435-427-3322
Mailing Address - Fax:435-427-3323
Practice Address - Street 1:229 SOUTH STATE
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:UT
Practice Address - Zip Code:84629-0009
Practice Address - Country:US
Practice Address - Phone:435-427-3322
Practice Address - Fax:435-427-3323
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1375861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice