Provider Demographics
NPI:1124372156
Name:BENCHMARK DENTAL OF LOVELAND, PC
Entity Type:Organization
Organization Name:BENCHMARK DENTAL OF LOVELAND, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:PRESTON
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:970-667-8782
Mailing Address - Street 1:640 E EISENHOWER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-3954
Mailing Address - Country:US
Mailing Address - Phone:970-667-8782
Mailing Address - Fax:970-686-5623
Practice Address - Street 1:640 E EISENHOWER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3954
Practice Address - Country:US
Practice Address - Phone:970-667-8782
Practice Address - Fax:970-686-5623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10414261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental