Provider Demographics
NPI:1881077691
Name:BASS, BENJAMIN CHARLES (DMD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:CHARLES
Last Name:BASS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 E BELLEVIEW AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-6022
Mailing Address - Country:US
Mailing Address - Phone:303-872-4250
Mailing Address - Fax:
Practice Address - Street 1:6501 E BELLEVIEW AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80111-6022
Practice Address - Country:US
Practice Address - Phone:303-872-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002025591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice