Individual
DR. BENNETT IRA LAX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
97 1/2 GEORGE ST, GREEN ISLAND, NY 12183-1115
(518) 272-2320
(518) 272-2322
Mailing address
97 1/2 GEORGE ST, GREEN ISLAND, NY 12183-1115
(518) 272-2320
(518) 272-2322
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
031327
NY
Other
Enumeration date
07/19/2006
Last updated
07/08/2007
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