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Individual
DR. JEFFREY A. BENNETT
Active
Individual
DR. JEFFREY A. BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12009948
IN
1223G0001X
General Practice Dentistry
144144
AK
1223G0001X
General Practice Dentistry
D10779
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200196820
—
IN
Enumeration date
01/04/2007
Last updated
08/25/2020
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