Provider Demographics
NPI:1730321373
Name:BENNETT, ANTOINETTE SMITH
Entity Type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:SMITH
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 MEADOW FARM DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-7445
Mailing Address - Country:US
Mailing Address - Phone:804-683-3298
Mailing Address - Fax:
Practice Address - Street 1:1812 MEADOW FARM DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-7445
Practice Address - Country:US
Practice Address - Phone:804-683-3298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor