Individual
MICHAEL BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3703 N KICKAPOO AVE, SHAWNEE, OK 74804-1703
(405) 275-0640
(405) 225-3008
Mailing address
400 RIVERWALK TER STE 250, JENKS, OK 74037-5619
(918) 998-0996
(918) 235-9079
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7543
OK
Other
Enumeration date
04/28/2022
Last updated
04/28/2022
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