Individual
DAVID BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
247 W 2230 N, PROVO, UT 84604-1587
(801) 275-1414
Mailing address
247 W 2230 N, PROVO, UT 84604-1587
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
622405859922
UT
Other
Enumeration date
05/23/2007
Last updated
07/08/2007
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