Provider Demographics
NPI:1629297726
Name:ROBERT J. BENKE, D.D.S., P.C.
Entity Type:Organization
Organization Name:ROBERT J. BENKE, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BENKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-356-2120
Mailing Address - Street 1:3705 W 12TH ST STE 3C
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2550
Mailing Address - Country:US
Mailing Address - Phone:970-356-2120
Mailing Address - Fax:970-356-1013
Practice Address - Street 1:3705 W 12TH ST STE 3C
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2550
Practice Address - Country:US
Practice Address - Phone:970-356-2120
Practice Address - Fax:970-356-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19753543Medicaid
CO02052538Medicaid