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NPI Code Detail

MEDICARE: DUSTIN LANSING BENNETT PA-C

MEDICARE: DUSTIN LANSING BENNETT PA-C
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
1363AS0400XSurgical Physician AssistantPA3394NV
2363A00000XPhysician AssistantPA3394NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11669039525OTHERDOD

General Provider Information

NPI Number : 1669039525
Entity Type Code : Individual
Provider Name (Legal Business Name) : DUSTIN LANSING BENNETT PA-C
Provider Business Mailing Address
First Line : 4700 LAS VEGAS BLVD N
Second Line :
City : NELLIS AFB
State : NV
Zip : 89191-6600
Country : US
Telephone Number : 702-653-2273
Fax Number :
Provider Business Practice Location Address
First Line : 4700 LAS VEGAS BLVD N
Second Line :
City : NELLIS AFB
State : NV
Zip : 89191-6600
Country : US
Telephone Number : 702-653-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2019
Last Update Date : 05/28/2026

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