Provider Demographics
NPI:1679739882
Name:BENNETT, JAMES PATRICK (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
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 1:27748 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-3919
Mailing Address - Country:US
Mailing Address - Phone:440-835-2121
Mailing Address - Fax:440-835-2345
Practice Address - Street 1:27748 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-3919
Practice Address - Country:US
Practice Address - Phone:440-835-2121
Practice Address - Fax:440-835-2345
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022859122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist