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General NPI Number Information
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NPI Number | 1881242329
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Entity Type | Organization
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Legal Business Name | TRAVIS W. BENNETT, DMD., PA.
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Dates
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Enumeration Date | 08/28/2019
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Last Update Date | 08/28/2019
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Provider Practice Location Address
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Address Line | 102965 OVERSEAS HWY
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City | KEY LARGO
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State | FL
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Zip | 33037-4690
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Country | US
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Telephone | 305-451-2616
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Fax |
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Provider Business Mailing Address
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Address Line | 102965 OVERSEAS HWY
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City | KEY LARGO
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State | FL
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Zip | 33037-4690
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Country | US
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Telephone | 305-451-2616
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRAVIS W BENNETT
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Credential | DMD
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Telephone | 305-451-2616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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