Provider Demographics
NPI:1871188466
Name:BENNETT, KAREN (RDH, PHDHP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RDH, PHDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 REBEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-2227
Mailing Address - Country:US
Mailing Address - Phone:570-899-4674
Mailing Address - Fax:
Practice Address - Street 1:2888 PA 29 SOUTH
Practice Address - Street 2:
Practice Address - City:NOXEN
Practice Address - State:PA
Practice Address - Zip Code:18636
Practice Address - Country:US
Practice Address - Phone:570-298-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist