Provider Demographics
NPI:1902216153
Name:BENNETT, JAMES JR (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BENNETT
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10188 NW 31ST ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3913
Mailing Address - Country:US
Mailing Address - Phone:954-752-7651
Mailing Address - Fax:954-345-4188
Practice Address - Street 1:10188 NW 31ST ST
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3913
Practice Address - Country:US
Practice Address - Phone:954-752-7651
Practice Address - Fax:954-345-4188
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN151031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry