Provider Demographics
NPI:1891186334
Name:BENNET FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:BENNET FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BENNET
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-662-2000
Mailing Address - Street 1:5606 BRIDGETOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OHIO
Mailing Address - Zip Code:45248
Mailing Address - Country:UM
Mailing Address - Phone:513-662-2000
Mailing Address - Fax:513-662-2000
Practice Address - Street 1:5606 BRIDGETOWN RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-4334
Practice Address - Country:US
Practice Address - Phone:513-662-2000
Practice Address - Fax:513-662-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16393122300000X
OH30024216122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty