Provider Demographics
NPI:1972862696
Name:BENNETT, PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
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 1:20 SW 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-5314
Mailing Address - Country:US
Mailing Address - Phone:360-250-0800
Mailing Address - Fax:360-240-0881
Practice Address - Street 1:20 SW 8TH AVE
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5314
Practice Address - Country:US
Practice Address - Phone:360-240-0800
Practice Address - Fax:360-240-0881
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601583701223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics