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: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 24TH AVE SW
MINOT ND
58701-6905
US

IV. Provider business mailing address

2305 37TH AVE SW
MINOT ND
58701-7669
US

V. Phone/Fax

Practice location:
  • Phone: 701-418-8000
  • Fax:
Mailing address:
  • Phone: 701-418-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: