Provider Demographics
NPI:1972832616
Name:BENCHMARK DENTAL, PC
Entity Type:Organization
Organization Name:BENCHMARK DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:307-856-9725
Mailing Address - Street 1:621NORTH 8TH STREET WEST
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501
Mailing Address - Country:US
Mailing Address - Phone:307-856-9725
Mailing Address - Fax:307-856-7075
Practice Address - Street 1:621 N 8TH ST W
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-3318
Practice Address - Country:US
Practice Address - Phone:307-856-9725
Practice Address - Fax:307-856-7075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1172122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty