Provider Demographics
NPI:1760772156
Name:BENNETT, GINA (CDA RDA)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CDA RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 W SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6915
Mailing Address - Country:US
Mailing Address - Phone:856-692-9333
Mailing Address - Fax:856-692-5565
Practice Address - Street 1:1103 W SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6915
Practice Address - Country:US
Practice Address - Phone:856-692-9333
Practice Address - Fax:856-692-5565
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DP00552800126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant