Individual
HARRISON TY BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1601 ALICE ST STE B, WAYCROSS, GA 31501-4578
(912) 285-5967
Mailing address
1601 ALICE ST STE B, WAYCROSS, GA 31501-4578
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN123201
GA
Other
Enumeration date
07/31/2023
Last updated
07/31/2023
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