# JACQUELINE BENNETT DDS PLC

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

## Provider details

- **NPI number:** 1316140585
- **Authorized official:** DR. JACQUELINE RAE BENNETT DDS (OWNER)
- **Authorized official phone:** (520) 886-3303

## Contact information

- **Practice address:** 1200 N EL DORADO PL, SUITE C320, TUCSON, AZ 85715-4637
- **Practice address phone:** (520) 886-3303
- **Practice address fax:** (520) 886-3305
- **Mailing address:** 4121 N LARREA LN, TUCSON, AZ 85750-2438
- **Mailing address phone:** (520) 886-3303
- **Mailing address fax:** (520) 886-3305

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D4891 | AZ | Yes |

## Other

- **Enumeration date:** 06/06/2007
- **Last updated:** 08/22/2020