MEDICARE: REDLANDS MESA FAMILY DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1104462878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDLANDS MESA FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	2412 PATTERSON RD STE 1
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1259
Country	:	US
Telephone Number	:	970-543-1393
Fax Number	:	970-549-0262

Provider Business Practice Location Address
First Line	:	2412 PATTERSON RD STE 1
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1259
Country	:	US
Telephone Number	:	970-543-1393
Fax Number	:	970-549-0262

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JULIE BENJAMIN
Credential	:	DDS
Telephone Number	:	970-549-1393

Provider Enumeration Date	:	11/18/2019
Last Update Date	:	11/18/2019

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