Provider Demographics
NPI:1750369146
Name:BENNETT, KENT STUART (DO, PHARMD, MPH)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:STUART
Last Name:BENNETT
Suffix:
Gender:M
Credentials:DO, PHARMD, MPH
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3990 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1152
Mailing Address - Country:US
Mailing Address - Phone:614-692-7145
Mailing Address - Fax:614-692-4816
Practice Address - Street 1:3990 E BROAD ST
Practice Address - Street 2:BUILDING 20 A POD, ROOM 143-S
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1152
Practice Address - Country:US
Practice Address - Phone:614-692-7145
Practice Address - Fax:614-692-4816
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.0105072083P0901X, 2083X0100X
IN02002509A208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN