Provider Demographics
NPI:1922489921
Name:UNITED DENTAL SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:UNITED DENTAL SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-593-6520
Mailing Address - Street 1:10305 NW 41ST ST
Mailing Address - Street 2:STE: 207
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2396
Mailing Address - Country:US
Mailing Address - Phone:305-593-6520
Mailing Address - Fax:
Practice Address - Street 1:10305 NW 41ST ST
Practice Address - Street 2:STE: 207
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2396
Practice Address - Country:US
Practice Address - Phone:305-593-6520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223E0200X, 1223P0300X, 1223X0400X
FLDN00107091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty