Provider Demographics
NPI:1285642058
Name:BENNETT, GREGORY DEAN (DDS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:DEAN
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 1:7745 WADSWORTH BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003
Mailing Address - Country:US
Mailing Address - Phone:303-421-7611
Mailing Address - Fax:303-421-2337
Practice Address - Street 1:7745 WADSWORTH BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003
Practice Address - Country:US
Practice Address - Phone:303-421-7611
Practice Address - Fax:303-421-2337
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO85781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice