Provider Demographics
NPI:1437334844
Name:ERNEST D. BENNETT DDS PC
Entity Type:Organization
Organization Name:ERNEST D. BENNETT DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-688-3008
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:80104-1959
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:80104-1959
Practice Address - Country:US
Practice Address - Phone:303-688-3008
Practice Address - Fax:303-688-1953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02037927Medicaid