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General NPI Number Information
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NPI Number | 1821679390
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Entity Type | Individual
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Provider Name | JOHN F BENNETT MR
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Gender | Male
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Dates
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Enumeration Date | 04/16/2021
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 1407 ORCHID DR UNIT A
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City | PRINCETON
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State | TX
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Zip | 75407-1240
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Country | US
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Telephone | 469-236-4511
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Fax |
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Provider Business Mailing Address
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Address Line | 101 N GREENVILLE AVE SUITE C # 15
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City | ALLEN
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State | TX
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Zip | 75002
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Country | US
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Telephone | 469-236-4511
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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 | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number | 2201
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License Number State | FL
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