Healthcare Provider Details

I. General information

NPI: 1467440313
Provider Name (Legal Business Name): JANE LAURA BENNETT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 08/07/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 FORTUNE DR SUITE 400
PAPILLION NE
68046-3421
US

IV. Provider business mailing address

545 FORTUNE DR SUITE 400
PAPILLION NE
68046-3421
US

V. Phone/Fax

Practice location:
  • Phone: 402-502-1256
  • Fax: 402-504-3322
Mailing address:
  • Phone: 402-502-1256
  • Fax: 402-504-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6410
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: