Provider Demographics
NPI:1083156517
Name:BENNETT DENTAL CORPORATION
Entity Type:Organization
Organization Name:BENNETT DENTAL CORPORATION
Other - Org Name:APNEA & BREATHING CLINIC BENNETT DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHASE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-638-3102
Mailing Address - Street 1:5230 CARROLL CANYON RD STE 326
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1781
Mailing Address - Country:US
Mailing Address - Phone:619-494-5091
Mailing Address - Fax:
Practice Address - Street 1:5230 CARROLL CANYON RD STE 326
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1781
Practice Address - Country:US
Practice Address - Phone:619-494-5091
Practice Address - Fax:619-881-0408
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENNETT DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-15
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61279122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty