Provider Demographics
NPI:1437250552
Name:BENNETT DENTAL GROUP
Entity type:Organization
Organization Name:BENNETT DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ASSISTANT/OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PFANKUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-429-3549
Mailing Address - Street 1:5130 W. 80TH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80030-4447
Mailing Address - Country:US
Mailing Address - Phone:303-429-3549
Mailing Address - Fax:303-427-9519
Practice Address - Street 1:5130 W. 80TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030-4447
Practice Address - Country:US
Practice Address - Phone:303-429-3549
Practice Address - Fax:303-427-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty