Provider Demographics
NPI:1316374416
Name:BENNETT, FARAH N (DDS)
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:N
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11470 CAMPUS ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3303
Mailing Address - Country:US
Mailing Address - Phone:716-888-0204
Mailing Address - Fax:
Practice Address - Street 1:23767 SUNNYMEAD BLVD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-0526
Practice Address - Country:US
Practice Address - Phone:951-924-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA628731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice