Provider Demographics
NPI:1851618904
Name:BENNETT, RICHARD DEAN (RB)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DEAN
Last Name:BENNETT
Suffix:
Gender:M
Credentials:RB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 W. TIOGA STREET
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-1810
Mailing Address - Country:US
Mailing Address - Phone:610-782-0324
Mailing Address - Fax:
Practice Address - Street 1:926 W TIOGA ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-4961
Practice Address - Country:US
Practice Address - Phone:610-782-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY560486163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse