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General NPI Number Information
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NPI Number | 1659587715
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Entity Type | Individual
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Provider Name | JAMES BRANDON BENNETT DMD
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Gender | Male
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 03/17/2010
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Provider Practice Location Address
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Address Line | 13820 OLD ST AUGUSTINE RD JACKSONVILLE
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City | JACKSONVILLE
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State | FL
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Zip | 32258-5424
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Country | US
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Telephone | 904-260-7700
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Fax | 904-260-7733
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Provider Business Mailing Address
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Address Line | 926 GREAT POND DR STE 2003
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-7244
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Country | US
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Telephone | 407-772-5124
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Fax | 407-788-3572
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN18368
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN013432
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License Number State | GA
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