Healthcare Provider Details

I. General information

NPI: 1255355467
Provider Name (Legal Business Name): DANIEL S BENNETT M.D, DABPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 18TH AVE SE
MINOT ND
58701-6785
US

IV. Provider business mailing address

1002 18TH AVE SE
MINOT ND
58701-6785
US

V. Phone/Fax

Practice location:
  • Phone: 701-852-6143
  • Fax: 701-773-9188
Mailing address:
  • Phone: 701-852-6143
  • Fax: 701-773-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number21450
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number21450
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number31118
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: