Provider Demographics
NPI:1821061482
Name:BENNETT, STEVEN ERIC (DOM)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ERIC
Last Name:BENNETT
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3908 JUAN TABO BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3971
Mailing Address - Country:US
Mailing Address - Phone:505-363-1428
Mailing Address - Fax:505-212-1087
Practice Address - Street 1:3908 JUAN TABO BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3971
Practice Address - Country:US
Practice Address - Phone:505-363-1428
Practice Address - Fax:505-212-1087
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDOM887171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist