MEDICARE: DR. IAN GEORGE DAVID BENNETT D.M.D.

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	122300000X	Dentist	73594959922	UT
2	122300000X	Dentist	14591	MD
3	122300000X	Dentist	D008195	AZ

General Provider Information

NPI Number	:	1629208897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IAN GEORGE DAVID BENNETT D.M.D.

Provider Business Mailing Address
First Line	:	7054 E COCHISE RD
Second Line	:	SUITE B-115
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85253-4546
Country	:	US
Telephone Number	:	480-991-3361
Fax Number	:	480-951-8925

Provider Business Practice Location Address
First Line	:	7054 E COCHISE RD
Second Line	:	SUITE B-115
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85253-4546
Country	:	US
Telephone Number	:	480-991-3361
Fax Number	:	480-951-8925

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2009
Last Update Date	:	06/03/2011

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Directions to “ DR. IAN GEORGE DAVID BENNETT D.M.D.” Practice Location

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