Provider Demographics
NPI:1689966525
Name:BENCHMARK DENTAL OF COLORADO, PC
Entity Type:Organization
Organization Name:BENCHMARK DENTAL OF COLORADO, PC
Other - Org Name:BENCHMARK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:PRESTON
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:970-686-7858
Mailing Address - Street 1:1555 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-5998
Mailing Address - Country:US
Mailing Address - Phone:970-686-7858
Mailing Address - Fax:970-686-5623
Practice Address - Street 1:1555 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-5998
Practice Address - Country:US
Practice Address - Phone:970-686-7858
Practice Address - Fax:970-686-5623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN104141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty