Provider Demographics
NPI:1912125162
Name:SPANISH SPRINGS FAMILY DENTAL
Entity Type:Organization
Organization Name:SPANISH SPRINGS FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BENNET
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-626-6556
Mailing Address - Street 1:5050 VISTA BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-2844
Mailing Address - Country:US
Mailing Address - Phone:775-626-6556
Mailing Address - Fax:775-626-6564
Practice Address - Street 1:5050 VISTA BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-2844
Practice Address - Country:US
Practice Address - Phone:775-626-6556
Practice Address - Fax:775-626-6564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV33231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty