Provider Demographics
NPI:1447678230
Name:BENZ, HOLLY
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:BENZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:DOBRENEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6055 W 46TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-1812
Mailing Address - Country:US
Mailing Address - Phone:303-423-8017
Mailing Address - Fax:
Practice Address - Street 1:6055 W 46TH AVE STE A
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-1812
Practice Address - Country:US
Practice Address - Phone:303-423-8017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD465592208000000X
CODR.0058869208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035987610001Medicaid