Individual
DR. MISTY MARIE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
420 POLIFKA DR BLDG 1042, SHAW AFB, SC 29152-5100
(803) 895-6951
Mailing address
420 POLIFKA DR BLDG 1042, SHAW AFB, SC 29152-5100
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12013810A
IN
Other
Enumeration date
03/23/2022
Last updated
10/11/2024
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