Provider Demographics
NPI:1245524800
Name:DARREN BENNETT DDS PC
Entity type:Organization
Organization Name:DARREN BENNETT DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-317-4215
Mailing Address - Street 1:4575 TENNYSON ST
Mailing Address - Street 2:#104
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2501
Mailing Address - Country:US
Mailing Address - Phone:303-274-1100
Mailing Address - Fax:
Practice Address - Street 1:2045 SHERIDAN BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:EDGEWATER
Practice Address - State:CO
Practice Address - Zip Code:80214-1304
Practice Address - Country:US
Practice Address - Phone:303-274-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO97481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty