Individual
JASON BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1234 N 900 E, PROVO, UT 84604-2725
(801) 854-9140
Mailing address
1234 N 900 E, PROVO, UT 84604-2725
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
13913977-9923
UT
Other
Enumeration date
04/17/2024
Last updated
05/03/2024
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