Provider Demographics
NPI:1649692005
Name:BENNETT, MAUREEN (DMD)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:TIMMENY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:189 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2627
Mailing Address - Country:US
Mailing Address - Phone:508-473-4220
Mailing Address - Fax:
Practice Address - Street 1:189 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2627
Practice Address - Country:US
Practice Address - Phone:508-473-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18560471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics