Provider Demographics
NPI:1003258641
Name:BENNETT, DUANE EVERETT II (DDS)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:EVERETT
Last Name:BENNETT
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 LOCKWOOD DR STE 240
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1563
Mailing Address - Country:US
Mailing Address - Phone:301-681-4812
Mailing Address - Fax:
Practice Address - Street 1:10801 LOCKWOOD DR STE 240
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1563
Practice Address - Country:US
Practice Address - Phone:301-681-4812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011502A122300000X
WADE604021321223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist