Provider Demographics
NPI:1740490994
Name:BENNETT, DEEANN MIGYANKA (DDS)
Entity type:Individual
Prefix:
First Name:DEEANN
Middle Name:MIGYANKA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DEEANN
Other - Middle Name:LEE
Other - Last Name:MIGYANKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:D,D,S,
Mailing Address - Street 1:220 S DENTON TAP RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5038
Mailing Address - Country:US
Mailing Address - Phone:972-462-9000
Mailing Address - Fax:972-393-6876
Practice Address - Street 1:220 S DENTON TAP RD
Practice Address - Street 2:SUITE 102
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-5038
Practice Address - Country:US
Practice Address - Phone:972-462-9000
Practice Address - Fax:972-393-6876
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice