Provider Demographics
NPI:1912787722
Name:MERENBLOOM, BENJAMIN ROSS (DDS)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ROSS
Last Name:MERENBLOOM
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MAIN ST UNIT O-203
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-7812
Mailing Address - Country:US
Mailing Address - Phone:970-766-7676
Mailing Address - Fax:
Practice Address - Street 1:275 MAIN ST UNIT O-203
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-7812
Practice Address - Country:US
Practice Address - Phone:970-766-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002059781223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice