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General NPI Number Information
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NPI Number | 1235304197
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Entity Type | Individual
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Provider Name | MICHAEL W BENNETT RDH
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Gender | Male
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 115 WILLOW CIRCLE DR
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City | LOVELAND
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State | CO
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Zip | 80537-7667
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Country | US
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Telephone | 970-669-2887
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Fax |
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Provider Business Mailing Address
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Address Line | 115 WILLOW CIRCLE DR
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City | LOVELAND
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State | CO
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Zip | 80537-7667
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Country | US
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Telephone | 970-669-2887
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 905344
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License Number State | CO
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