# TERRY R BENNETT DMD INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013201052
- **Authorized official:** DR. TERRY BENNETT D.M.D. (OWNER)
- **Authorized official phone:** (918) 582-8651

## Contact information

- **Practice address:** 1616 S DENVER AVE, TULSA, OK 74119-4233
- **Practice address phone:** (918) 582-8651
- **Practice address fax:** (918) 582-3903
- **Mailing address:** 1616 S DENVER AVE, TULSA, OK 74119-4233
- **Mailing address phone:** (918) 582-8651
- **Mailing address fax:** (918) 582-3903

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 3828 | OK | Yes |
| 332BC3200X | Customized Equipment (DME) | — | — | — |

## Other

- **Enumeration date:** 06/07/2011
- **Last updated:** 07/26/2011