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General NPI Number Information
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NPI Number | 1003258641
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Entity Type | Individual
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Provider Name | DUANE EVERETT BENNETT II DDS
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Gender | Male
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Dates
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Enumeration Date | 07/24/2013
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Last Update Date | 01/28/2022
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Provider Practice Location Address
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Address Line | 10801 LOCKWOOD DR STE 240
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City | SILVER SPRING
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State | MD
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Zip | 20901-1563
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Country | US
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Telephone | 301-681-4812
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Fax |
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Provider Business Mailing Address
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Address Line | 10801 LOCKWOOD DR STE 240
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City | SILVER SPRING
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State | MD
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Zip | 20901-1563
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Country | US
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Telephone | 301-681-4812
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12011502A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DE60402132
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License Number State | WA
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