=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346105897
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENNETT ORTHODONTICS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2025
-----------------------------------------------------
Last Update Date | 12/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 MEDICAL DR NE
-----------------------------------------------------
City | ROME
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30161-4912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-388-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 MEDICAL DR NE
-----------------------------------------------------
City | ROME
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30161-4912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-388-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DR. WILLIAM BENNETT
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 706-284-9600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------