Provider Demographics
NPI:1598798159
Name:BENNING, ALLEN NOEL (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:NOEL
Last Name:BENNING
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W ROCKRIMMON BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1776
Mailing Address - Country:US
Mailing Address - Phone:719-598-7700
Mailing Address - Fax:719-536-0862
Practice Address - Street 1:415 W ROCKRIMMON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1776
Practice Address - Country:US
Practice Address - Phone:719-598-7700
Practice Address - Fax:719-536-0862
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11OtherSTATE LICENSE NUMBER