Provider Demographics
NPI:1750429577
Name:BENNETT, BARRY EDWARD (DMD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:EDWARD
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 1:2904 PROFESSIONAL PKWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-6502
Mailing Address - Country:US
Mailing Address - Phone:706-860-0650
Mailing Address - Fax:706-860-1503
Practice Address - Street 1:2904 PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-6502
Practice Address - Country:US
Practice Address - Phone:706-860-0650
Practice Address - Fax:706-860-1503
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0093291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice