Healthcare Provider Details

I. General information

NPI: 1346334216
Provider Name (Legal Business Name): JOHN T BENNETT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 SHEPHERD LN
BALCH SPRINGS TX
75180-2325
US

IV. Provider business mailing address

204 COIT RD SUITE 100
PLANO TX
75075-5717
US

V. Phone/Fax

Practice location:
  • Phone: 972-286-5711
  • Fax: 972-286-6106
Mailing address:
  • Phone: 972-309-1600
  • Fax: 972-309-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0008500
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: