# BENDER MEDICAL GROUP, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BENDER MEDICAL GROUP, INC
- **Other names:** Miramont Family Medicine
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1619421351
- **Legal business name:** BENDER MEDICAL GROUP, INC
- **Authorized official:** JULIE M DESAIRE (CHIEF BUSINESS DEVELOPMENT OFFICER)
- **Authorized official phone:** (970) 225-5107

## Contact information

- **Practice address:** 313 W DRAKE RD, FORT COLLINS, CO 80526-2846
- **Practice address phone:** (970) 482-8881
- **Practice address fax:** (970) 482-9646
- **Mailing address:** 4674 SNOW MESA DR STE 140, FORT COLLINS, CO 80528-8614
- **Mailing address phone:** (970) 225-5107

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/11/2016
- **Last updated:** 08/11/2016