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General NPI Number Information
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NPI Number | 1124372156
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Entity Type | Organization
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Legal Business Name | BENCHMARK DENTAL OF LOVELAND, PC
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Dates
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Enumeration Date | 10/29/2012
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Last Update Date | 10/29/2012
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Provider Practice Location Address
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Address Line | 640 E EISENHOWER BLVD SUITE 100
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City | LOVELAND
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State | CO
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Zip | 80537-3954
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Country | US
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Telephone | 970-667-8782
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Fax | 970-686-5623
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Provider Business Mailing Address
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Address Line | 640 E EISENHOWER BLVD SUITE 100
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City | LOVELAND
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State | CO
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Zip | 80537-3954
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Country | US
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Telephone | 970-667-8782
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Fax | 970-686-5623
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. JOSHUA PRESTON FOWLER
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Credential | D.M.D.
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Telephone | 970-667-8782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 10414
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License Number State | CO
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