Provider Demographics
NPI:1356569909
Name:WEST-BENNETT, KIRSTEN LIESL (8172)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:LIESL
Last Name:WEST-BENNETT
Suffix:
Gender:F
Credentials:8172
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4194 W. 99TH CT.
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031
Mailing Address - Country:US
Mailing Address - Phone:303-657-3303
Mailing Address - Fax:
Practice Address - Street 1:5130 W. 80TH AVE. SUITE 202
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030
Practice Address - Country:US
Practice Address - Phone:303-429-3549
Practice Address - Fax:303-427-9519
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO81721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice