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General NPI Number Information
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NPI Number | 1750438792
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Entity Type | Individual
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Provider Name | JEFFREY A. BENNETT D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 08/25/2020
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Provider Practice Location Address
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Address Line | 1521 ROCKFORD CT
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City | KOKOMO
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State | IN
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Zip | 46902-3207
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Country | US
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Telephone | 765-455-4270
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Fax | 765-455-4275
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Provider Business Mailing Address
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Address Line | 5174 WOODWORTH DR
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City | MOUNT HOOD PARKDALE
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State | OR
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Zip | 97041-8737
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Country | US
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Telephone | 765-438-4228
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D10779
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License Number State | OR
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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 | 144144
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12009948
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License Number State | IN
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