Provider Demographics
NPI:1740355072
Name:GUM, BENNETT GM (DDS)
Entity type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:GM
Last Name:GUM
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 1:1010 S KING ST STE 403
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1705
Mailing Address - Country:US
Mailing Address - Phone:808-589-2486
Mailing Address - Fax:808-598-6698
Practice Address - Street 1:1010 S KING ST STE 403
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1705
Practice Address - Country:US
Practice Address - Phone:808-589-2486
Practice Address - Fax:808-598-6698
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI18891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice