Healthcare Provider Details

I. General information

NPI: 1750369146
Provider Name (Legal Business Name): KENT STUART BENNETT DO, PHARMD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 E BROAD ST BUILDING 20 A POD, ROOM 143-S
COLUMBUS OH
43213-1152
US

IV. Provider business mailing address

3990 E BROAD ST
COLUMBUS OH
43213-1152
US

V. Phone/Fax

Practice location:
  • Phone: 614-692-7145
  • Fax: 614-692-4816
Mailing address:
  • Phone: 614-692-7145
  • Fax: 614-692-4816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number34.010507
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License Number02002509A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number34.010507
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: