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NPI Code Detail

MEDICARE: JOHN T BENNETT D.D.S.

MEDICARE: JOHN T BENNETT D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry0008500TX

General Provider Information

NPI Number : 1346334216
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN T BENNETT D.D.S.
Provider Business Mailing Address
First Line : 204 COIT RD
Second Line : SUITE 100
City : PLANO
State : TX
Zip : 75075-5717
Country : US
Telephone Number : 972-309-1600
Fax Number : 972-309-1601
Provider Business Practice Location Address
First Line : 3501 SHEPHERD LN
Second Line :
City : BALCH SPRINGS
State : TX
Zip : 75180-2325
Country : US
Telephone Number : 972-286-5711
Fax Number : 972-286-6106
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 07/08/2007

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