Provider Demographics
NPI:1245206796
Name:BENNETT, ERNEST D (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:D
Last Name:BENNETT
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 1:1189 S. PERRY ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104
Mailing Address - Country:US
Mailing Address - Phone:303-688-3008
Mailing Address - Fax:303-688-1953
Practice Address - Street 1:1189 S. PERRY ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104
Practice Address - Country:US
Practice Address - Phone:303-688-3008
Practice Address - Fax:303-688-1953
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO79101534Medicaid