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General NPI Number Information
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NPI Number | 1154706182
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Entity Type | Individual
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Provider Name | BRAD BENNETT DMD
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Gender | Male
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Dates
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Enumeration Date | 07/20/2015
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 8930 BROWN DR
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City | BETHESDA
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State | MD
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Zip | 20889-5629
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Country | US
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Telephone | 301-295-3148
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Fax |
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Provider Business Mailing Address
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Address Line | 554 KEILY ST BUMED CENTRALIZED CRED & PRIVILEGING
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City | JACKSONVILLE
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State | FL
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Zip | 32212
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Country | US
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Telephone |
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 30.024576
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License Number State | OH
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