Provider Demographics
NPI:1912310756
Name:CRANIOFACIAL PAIN & SLEEP DISORDERS CLINIC
Entity type:Organization
Organization Name:CRANIOFACIAL PAIN & SLEEP DISORDERS CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHASE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-638-3102
Mailing Address - Street 1:7502 W 80TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-2139
Mailing Address - Country:US
Mailing Address - Phone:303-421-2696
Mailing Address - Fax:303-421-2179
Practice Address - Street 1:7502 W 80TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-2139
Practice Address - Country:US
Practice Address - Phone:303-421-2696
Practice Address - Fax:303-421-2179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment