Provider Demographics
NPI:1124695945
Name:BENCHMARK DENTAL LLC
Entity type:Organization
Organization Name:BENCHMARK DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:BELANGER
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-692-6557
Mailing Address - Street 1:PO BOX 514
Mailing Address - Street 2:
Mailing Address - City:BELGRADE LAKES
Mailing Address - State:ME
Mailing Address - Zip Code:04918-0514
Mailing Address - Country:US
Mailing Address - Phone:207-692-6557
Mailing Address - Fax:
Practice Address - Street 1:104 CORN SHOP LN
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6401
Practice Address - Country:US
Practice Address - Phone:207-778-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental