Provider Demographics
NPI:1699308866
Name:SIGNATURE DENTAL PARTNERS LLC
Entity type:Organization
Organization Name:SIGNATURE DENTAL PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF INTEGRATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-234-8490
Mailing Address - Street 1:410 N 44TH ST STE 290
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7622
Mailing Address - Country:US
Mailing Address - Phone:480-626-4154
Mailing Address - Fax:
Practice Address - Street 1:410 N 44TH ST STE 290
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-7622
Practice Address - Country:US
Practice Address - Phone:480-626-4154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-17
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty