Healthcare Provider Details

I. General information

NPI: 1184563611
Provider Name (Legal Business Name): TIMOTHY BENNET, DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 W BAGLEY RD
BEREA OH
44017-1356
US

IV. Provider business mailing address

633 W BAGLEY RD
BEREA OH
44017-1356
US

V. Phone/Fax

Practice location:
  • Phone: 440-234-4646
  • Fax:
Mailing address:
  • Phone: 440-234-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY JOHN BENNET
Title or Position: OWNER
Credential: DDS
Phone: 440-234-4646