Provider Demographics
NPI:1962443663
Name:RICHARD L BENNETT DDS PA
Entity Type:Organization
Organization Name:RICHARD L BENNETT DDS PA
Other - Org Name:DRS BENNETT & BENNETT
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-343-9220
Mailing Address - Street 1:909 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801
Mailing Address - Country:US
Mailing Address - Phone:620-343-9220
Mailing Address - Fax:620-343-9221
Practice Address - Street 1:909 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801
Practice Address - Country:US
Practice Address - Phone:620-343-9220
Practice Address - Fax:620-343-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4308122300000X
KS6600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS05920OtherBLUE CROSS BLUE SHIELD
KS19201OtherBLUE CROSS BLUE SHIELD