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Individual
MR. MAC LEON BENNETT III
Active
Individual
MR. MAC LEON BENNETT III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8253
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008028501
—
TX
01
—
86D579
BLUE CROSS BLUE SHIELD
TX
01
—
G6025601
TEXAS CHIP
TX
Enumeration date
08/31/2006
Last updated
06/19/2008
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