Provider Demographics
NPI:1154092773
Name:DR RON BENHAM LLC
Entity Type:Organization
Organization Name:DR RON BENHAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BENHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMFT
Authorized Official - Phone:303-352-1975
Mailing Address - Street 1:3220 OTIS ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6359
Mailing Address - Country:US
Mailing Address - Phone:303-352-1975
Mailing Address - Fax:
Practice Address - Street 1:8120 SHERIDAN BLVD STE 108C
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80003-6144
Practice Address - Country:US
Practice Address - Phone:303-352-1975
Practice Address - Fax:303-352-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty