Provider Demographics
NPI:1184097032
Name:BENNETT, JODI LIN (RDH)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LIN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4683
Mailing Address - Country:US
Mailing Address - Phone:207-563-8668
Mailing Address - Fax:
Practice Address - Street 1:748 MAIN ST
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4683
Practice Address - Country:US
Practice Address - Phone:207-563-8668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-01
Last Update Date:2015-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH3006124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist