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General NPI Number Information
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NPI Number | 1972832616
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Entity Type | Organization
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Legal Business Name | BENCHMARK DENTAL, PC
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Dates
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Enumeration Date | 12/09/2009
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Last Update Date | 02/05/2015
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Provider Practice Location Address
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Address Line | 621 N 8TH ST W
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City | RIVERTON
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State | WY
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Zip | 82501-3318
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Country | US
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Telephone | 307-856-9725
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Fax | 307-856-7075
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Provider Business Mailing Address
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Address Line | 621NORTH 8TH STREET WEST
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City | RIVERTON
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State | WY
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Zip | 82501
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Country | US
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Telephone | 307-856-9725
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Fax | 307-856-7075
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Authorized Official
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Title or Position | DR. / OWNER
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Name | DR. SPENCER W. SMITH
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Credential | D.D.S
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Telephone | 307-856-9725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1172
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License Number State | WY
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