MEDICARE: DEEANN BENNETT, D.D.S., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	19883	TX

General Provider Information

NPI Number	:	1124239066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEEANN BENNETT, D.D.S., P.A.

Provider Business Mailing Address
First Line	:	220 S DENTON TAP RD
Second Line	:	SUITE 102
City	:	COPPELL
State	:	TX
Zip	:	75019-5098
Country	:	US
Telephone Number	:	972-462-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 S DENTON TAP RD
Second Line	:	SUITE 102
City	:	COPPELL
State	:	TX
Zip	:	75019-5098
Country	:	US
Telephone Number	:	972-462-9000
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DEEANN MIGYANKA BENNETT
Credential	:	D.D.S.
Telephone Number	:	972-462-9000

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	08/22/2020

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