Provider Demographics
NPI:1063895761
Name:BENJAMIN T DONN DDS PC
Entity type:Organization
Organization Name:BENJAMIN T DONN DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:DONN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-576-6551
Mailing Address - Street 1:202 E CHEYENNE MOUNTAIN BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3769
Mailing Address - Country:US
Mailing Address - Phone:719-576-6551
Mailing Address - Fax:719-576-8722
Practice Address - Street 1:202 E CHEYENNE MOUNTAIN BLVD STE E
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3769
Practice Address - Country:US
Practice Address - Phone:719-576-6551
Practice Address - Fax:719-576-8722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO201990122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7357930001Medicare NSC