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General NPI Number Information
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NPI Number | 1033205901
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Entity Type | Individual
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Provider Name | TIMOTHY PAUL BENNETT DDS
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Gender | Male
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 01/30/2014
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Provider Practice Location Address
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Address Line | 721 PLEASANT GROVE BLVD STE 150
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City | ROSEVILLE
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State | CA
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Zip | 95678-6181
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Country | US
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Telephone | 916-865-2252
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Fax |
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Provider Business Mailing Address
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Address Line | 166 PIZARRO AVE
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City | NOVATO
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State | CA
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Zip | 94949-6149
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Country | US
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Telephone | 415-302-7301
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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 | 28517
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License Number State | CA
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