Individual
BEN LAWRENCE BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
201 W LAKEWAY RD STE 517, GILLETTE, WY 82718-6343
(719) 551-0556
(719) 219-1376
Mailing address
PO BOX 592, ALLIANCE, NE 69301-0592
(719) 551-0556
(719) 219-1376
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
5387
NE
122300000X
Dentist
Primary
769
WY
122300000X
Dentist
D1042
SD
Other
Enumeration date
07/17/2020
Last updated
07/17/2020
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