Provider Demographics
NPI:1760964159
Name:BENNETT, DAVID PAUL
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:BENNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4484 LANDMARK RD
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-8922
Mailing Address - Country:US
Mailing Address - Phone:614-264-6614
Mailing Address - Fax:
Practice Address - Street 1:4484 LANDMARK RD
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-8922
Practice Address - Country:US
Practice Address - Phone:614-264-6614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide