Provider Demographics
NPI:1063964633
Name:STERLING DENTAL PLLC
Entity type:Organization
Organization Name:STERLING DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-705-0266
Mailing Address - Street 1:5616 S GIBRALTAR WAY UNIT E
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5305
Mailing Address - Country:US
Mailing Address - Phone:303-624-4884
Mailing Address - Fax:
Practice Address - Street 1:629 HOLLY DR
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4539
Practice Address - Country:US
Practice Address - Phone:970-522-8518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BASSLEGATE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN002028141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty