Provider Demographics
NPI:1457565897
Name:B. LAWRENCE BENNETT DDS PC
Entity Type:Organization
Organization Name:B. LAWRENCE BENNETT DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-551-0556
Mailing Address - Street 1:PO BOX 592
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-0592
Mailing Address - Country:US
Mailing Address - Phone:719-551-0556
Mailing Address - Fax:
Practice Address - Street 1:201 W LAKEWAY RD STE 517
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718
Practice Address - Country:US
Practice Address - Phone:719-551-0556
Practice Address - Fax:719-219-1376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105761122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty