Provider Demographics
NPI:1881959518
Name:BENNETT, LEIGH UNDERWOOD (DMD)
Entity type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:UNDERWOOD
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4226 HARTLEY BRIDGE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-4116
Mailing Address - Country:US
Mailing Address - Phone:478-957-2486
Mailing Address - Fax:
Practice Address - Street 1:4226 HARTLEY BRIDGE RD STE 102
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216
Practice Address - Country:US
Practice Address - Phone:478-957-2486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0145401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice