Provider Demographics
NPI:1558789875
Name:BENNETT DENTAL CENTER LLC
Entity Type:Organization
Organization Name:BENNETT DENTAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:K
Authorized Official - Last Name:COFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-480-4580
Mailing Address - Street 1:PO BOX 514
Mailing Address - Street 2:
Mailing Address - City:BENNETT
Mailing Address - State:CO
Mailing Address - Zip Code:80102-0514
Mailing Address - Country:US
Mailing Address - Phone:303-644-5058
Mailing Address - Fax:303-644-5270
Practice Address - Street 1:280 E COLFAX AVE
Practice Address - Street 2:UNIT 1
Practice Address - City:BENNETT
Practice Address - State:CO
Practice Address - Zip Code:80102-0514
Practice Address - Country:US
Practice Address - Phone:303-644-5058
Practice Address - Fax:303-644-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO452919129261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental