Healthcare Provider Details

I. General information

NPI: 1558789875
Provider Name (Legal Business Name): BENNETT DENTAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 E COLFAX AVE UNIT 1
BENNETT CO
80102-0514
US

IV. Provider business mailing address

PO BOX 514
BENNETT CO
80102-0514
US

V. Phone/Fax

Practice location:
  • Phone: 303-644-5058
  • Fax: 303-644-5270
Mailing address:
  • Phone: 303-644-5058
  • Fax: 303-644-5270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number452919129
License Number StateCO

VIII. Authorized Official

Name: DR. PAULA K COFFEE
Title or Position: DOCTOR/OWNER
Credential: DDS
Phone: 720-480-4580