Provider Demographics
NPI:1326003922
Name:BENNETT, KATHLEEN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:M
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 1:2560 PERKINS LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-2723
Mailing Address - Country:US
Mailing Address - Phone:513-871-9111
Mailing Address - Fax:513-467-0943
Practice Address - Street 1:222 PIEDMONT AVE
Practice Address - Street 2:SUITE 8300
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-4231
Practice Address - Country:US
Practice Address - Phone:513-871-9111
Practice Address - Fax:513-467-0943
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0382344122300000X
OH21710122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6267980001Medicare NSC