Provider Demographics
NPI:1124490206
Name:BENNETT, HUNTER (DMD)
Entity type:Individual
Prefix:
First Name:HUNTER
Middle Name:
Last Name:BENNETT
Suffix:
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 1:8843 VENICE LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9743
Mailing Address - Country:US
Mailing Address - Phone:602-478-7341
Mailing Address - Fax:
Practice Address - Street 1:8899 TIMBERWILDE DR STE 3
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-7896
Practice Address - Country:US
Practice Address - Phone:239-498-7668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN215011223E0200X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1548340276Medicaid