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: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W GRAND AVE
DAYTON OH
45405-7538
US

IV. Provider business mailing address

405 W GRAND AVE
DAYTON OH
45405-7538
US

V. Phone/Fax

Practice location:
  • Phone: 937-723-3248
  • Fax:
Mailing address:
  • Phone: 937-723-4124
  • Fax:

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 Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number34.010507
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License Number02002509A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number34.010507
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: