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General NPI Number Information
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NPI Number | 1558789875
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Entity Type | Organization
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Legal Business Name | BENNETT DENTAL CENTER LLC
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Dates
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Enumeration Date | 04/03/2014
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Last Update Date | 04/03/2014
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Provider Practice Location Address
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Address Line | 280 E COLFAX AVE UNIT 1
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City | BENNETT
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State | CO
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Zip | 80102-0514
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Country | US
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Telephone | 303-644-5058
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Fax | 303-644-5270
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Provider Business Mailing Address
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Address Line | PO BOX 514
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City | BENNETT
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State | CO
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Zip | 80102-0514
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Country | US
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Telephone | 303-644-5058
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Fax | 303-644-5270
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. PAULA K COFFEE
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Credential | DDS
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Telephone | 720-480-4580
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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 | 452919129
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License Number State | CO
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