Provider Demographics
NPI:1508942491
Name:BENNETT, ROBERT C (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:BENNETT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:ALAN
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:214 FLORENCE DR
Mailing Address - Street 2:
Mailing Address - City:NEW STANTON
Mailing Address - State:PA
Mailing Address - Zip Code:15672-9762
Mailing Address - Country:US
Mailing Address - Phone:724-925-1894
Mailing Address - Fax:
Practice Address - Street 1:506 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:MCMECHEN
Practice Address - State:WV
Practice Address - Zip Code:26040-1041
Practice Address - Country:US
Practice Address - Phone:304-233-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV-28701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice