Provider Demographics
NPI:1265117907
Name:BENCHMARK DENTAL GROUP LLC
Entity type:Organization
Organization Name:BENCHMARK DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-926-2500
Mailing Address - Street 1:2330 TOWNE LAKE PKWY
Mailing Address - Street 2:BUILDING 700, SUITE 130
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189
Mailing Address - Country:US
Mailing Address - Phone:770-926-2500
Mailing Address - Fax:770-517-7911
Practice Address - Street 1:2330 TOWNE LAKE PKWY
Practice Address - Street 2:BUILDING 700, SUITE 130
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189
Practice Address - Country:US
Practice Address - Phone:770-926-2500
Practice Address - Fax:770-517-7911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty