Provider Demographics
NPI:1952470346
Name:BENNETT, CHRISTOPHER JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:BENNETT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 SE 12TH PL
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-9311
Mailing Address - Country:US
Mailing Address - Phone:503-861-6240
Mailing Address - Fax:503-861-6358
Practice Address - Street 1:599 TOMALES RD
Practice Address - Street 2:BLDG 225
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-5002
Practice Address - Country:US
Practice Address - Phone:707-765-7591
Practice Address - Fax:707-765-7521
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3323122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist