# DR. JEFFREY A. BENNETT

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1750438792
- **Gender:** Man
- **Credential:** D.D.S.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12009948 | IN | Yes |
| 1223G0001X | General Practice Dentistry | 144144 | AK | — |
| 1223G0001X | General Practice Dentistry | D10779 | OR | — |

## Other

- **Enumeration date:** 01/04/2007
- **Last updated:** 08/25/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200196820 | — | IN |