=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942460936
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENNER & SHARP FAMILY DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2008
-----------------------------------------------------
Last Update Date | 06/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3400 W 16TH ST SUITE 8-E
-----------------------------------------------------
City | GREELEY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80634-6862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-351-0400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3400 W 16TH ST SUITE 8-E
-----------------------------------------------------
City | GREELEY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80634-6862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-351-0400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. JULIE SHARP
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 970-351-0400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 8674
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------