Healthcare Provider Details

I. General information

NPI: 1386087500
Provider Name (Legal Business Name): WILLIAM BENNETT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MEDICAL DR NE
ROME GA
30161-4912
US

IV. Provider business mailing address

10 MEDICAL DR NE
ROME GA
30161-4912
US

V. Phone/Fax

Practice location:
  • Phone: 706-388-5000
  • Fax:
Mailing address:
  • Phone: 706-388-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number14105
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: