Provider Demographics
NPI:1477092500
Name:SIGNATURE DENTISTRY OF AURORA
Entity Type:Organization
Organization Name:SIGNATURE DENTISTRY OF AURORA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-690-0877
Mailing Address - Street 1:13764 E QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-1129
Mailing Address - Country:US
Mailing Address - Phone:303-423-7298
Mailing Address - Fax:
Practice Address - Street 1:13764 E QUINCY AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-1129
Practice Address - Country:US
Practice Address - Phone:303-423-7298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7665122300000X
CO10483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1003936147OtherINDIVIDUAL NPI
CO1386911857OtherINDIVIDUAL NPI