Provider Demographics
NPI:1528398344
Name:BENZLEY PEDIATRIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:BENZLEY PEDIATRIC DENTISTRY, LLC
Other - Org Name:CASTLE ROCK SMILES PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAYNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BENZLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-660-5373
Mailing Address - Street 1:753 MALETA LN STE 104
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-7605
Mailing Address - Country:US
Mailing Address - Phone:303-660-5373
Mailing Address - Fax:303-660-5374
Practice Address - Street 1:753 MALETA LN STE 104
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-7605
Practice Address - Country:US
Practice Address - Phone:303-660-5373
Practice Address - Fax:303-660-5374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO98751223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty