Healthcare Provider Details

I. General information

NPI: 1497564892
Provider Name (Legal Business Name): LINDEN BENNETCH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2025
Last Update Date: 06/22/2025
Certification Date: 06/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S LINCOLN AVE
LEBANON PA
17042-7529
US

IV. Provider business mailing address

301 VALLEY VIEW RD
MYERSTOWN PA
17067-3073
US

V. Phone/Fax

Practice location:
  • Phone: 717-272-6621
  • Fax:
Mailing address:
  • Phone: 717-639-4908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS044586
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: