Provider Demographics
NPI:1629208897
Name:BENNETT, IAN GEORGE DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:GEORGE DAVID
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 1:7054 E COCHISE RD
Mailing Address - Street 2:SUITE B-115
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-4546
Mailing Address - Country:US
Mailing Address - Phone:480-991-3361
Mailing Address - Fax:480-951-8925
Practice Address - Street 1:7054 E COCHISE RD
Practice Address - Street 2:SUITE B-115
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-4546
Practice Address - Country:US
Practice Address - Phone:480-991-3361
Practice Address - Fax:480-951-8925
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT73594959922122300000X
MD14591122300000X
AZD008195122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist