Provider Demographics
NPI:1619499415
Name:BENNETT, GEOFFREY WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:WILLIAM
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 1:1299 SW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-5307
Mailing Address - Country:US
Mailing Address - Phone:786-478-1739
Mailing Address - Fax:
Practice Address - Street 1:14811 LYONS RD STE 102
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-9009
Practice Address - Country:US
Practice Address - Phone:561-366-8478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN228071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice