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General NPI Number Information
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NPI Number | 1962167809
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Entity Type | Organization
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Legal Business Name | ADAM BENNETT LLC
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 11/06/2021
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Provider Practice Location Address
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Address Line | 168 S PAYNE STEWART DR STE 100
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City | BRANSON
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State | MO
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Zip | 65616-2718
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Country | US
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Telephone | 417-263-3127
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Fax |
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Provider Business Mailing Address
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Address Line | 278 DANDY WAY
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City | BRANSON
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State | MO
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Zip | 65616-8666
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Country | US
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Telephone | 870-577-7286
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Fax |
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. ADAM MICHAEL BENNETT
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Credential | DDS
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Telephone | 870-577-7286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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