Provider Demographics
NPI:1326183476
Name:BENNETT, DONALD PHILLIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:PHILLIP
Last Name:BENNETT
Suffix:
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 1:1010 COMMON STREET
Mailing Address - Street 2:SUITE 810
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-9050
Mailing Address - Country:US
Mailing Address - Phone:504-523-4882
Mailing Address - Fax:504-523-2113
Practice Address - Street 1:1010 COMMON STREET
Practice Address - Street 2:SUITE 810
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-9050
Practice Address - Country:US
Practice Address - Phone:504-523-4882
Practice Address - Fax:504-523-2113
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA40461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAA2013OtherBLUE CROSS BLUE SHIELD