Provider Demographics
NPI:1467440313
Name:BENNETT, JANE LAURA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:LAURA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:545 FORTUNE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3421
Mailing Address - Country:US
Mailing Address - Phone:402-502-1256
Mailing Address - Fax:402-504-3322
Practice Address - Street 1:545 FORTUNE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3421
Practice Address - Country:US
Practice Address - Phone:402-502-1256
Practice Address - Fax:402-504-3322
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE64101223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025256300Medicaid