Provider Demographics
NPI:1346572252
Name:BENNETT, JENNIFER JEAN (CDA, EFDA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JEAN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CDA, EFDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 FAYCREST RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-5974
Mailing Address - Country:US
Mailing Address - Phone:614-321-4332
Mailing Address - Fax:
Practice Address - Street 1:3301 FAYCREST RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-5974
Practice Address - Country:US
Practice Address - Phone:614-321-4332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL201692126800000X
OHEFDA-01263126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant