Healthcare Provider Details

I. General information

NPI: 1750492252
Provider Name (Legal Business Name): ROBIN C BENNETT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 FRANKLIN BLVD
LEMOORE CA
93246-4500
US

IV. Provider business mailing address

3184 PIKE PLZ
LEMOORE CA
93245-2234
US

V. Phone/Fax

Practice location:
  • Phone: 559-998-4215
  • Fax:
Mailing address:
  • Phone: 414-339-8233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6046-15
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6046
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: