| Benchmark Dental Of Greeley | |
|
3400 W 16th St Ste 8e Greeley CO 80634-6862 | |
| (970) 352-5448 | |
| Not Available |
| Full Name | Benchmark Dental Of Greeley |
|---|---|
| Speciality | Clinic/Center |
| Location | 3400 W 16th St Ste 8e, Greeley, Colorado |
| Authorized Official Name and Position | Shawn Michael Custer (OWNER DOCTOR) |
| Authorized Official Contact | 4026694971 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Benchmark Dental Of Greeley 3400 W 16th St Ste 8e Greeley CO 80634-6862 Ph: (970) 352-5448 | Benchmark Dental Of Greeley 3400 W 16th St Ste 8e Greeley CO 80634-6862 Ph: (970) 352-5448 |
| NPI Number | 1023506433 |
|---|---|
| Provider Enumeration Date | 05/01/2018 |
| Last Update Date | 09/10/2021 |
| Medicare PECOS PAC ID | 8022415934 |
|---|---|
| Medicare Enrollment ID | O20210920002604 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023506433 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 00203394 (Colorado) | Primary |
| Provider Name | Shawn Michael Custer |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1801324298 PECOS PAC ID: 9931506847 Enrollment ID: I20210920002834 |
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