Individual
JAMES BRANDON BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
13820 OLD ST AUGUSTINE RD, JACKSONVILLE, JACKSONVILLE, FL 32258-5424
(904) 260-7700
(904) 260-7733
Mailing address
926 GREAT POND DR STE 2003, ALTAMONTE SPRINGS, FL 32714-7244
(407) 772-5124
(407) 788-3572
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DN013432
GA
1223G0001X
General Practice Dentistry
Primary
DN18368
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000769100
—
FL
Enumeration date
05/15/2007
Last updated
03/17/2010
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