Provider Demographics
NPI:1083832745
Name:BENNETT, SCOTT STEVEN (8060)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:STEVEN
Last Name:BENNETT
Suffix:
Gender:M
Credentials:8060
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4194 W. 99TH CT.
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031
Mailing Address - Country:US
Mailing Address - Phone:303-657-3303
Mailing Address - Fax:
Practice Address - Street 1:5130 W. 80TH AVE SUITE 202
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030
Practice Address - Country:US
Practice Address - Phone:303-429-3549
Practice Address - Fax:303-477-9519
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO80601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice