Individual provider · NPI-1

Michael Bennett, DMD

Dentist, General Practice · Shawnee, OK

NPI number1073258786
StatusActive
Last updated in NPPESApr 28, 2022

Details

NPI
1073258786
Entity type
Individual (NPI-1)
Name
Michael Bennett
Credential
DMD
Sex
Male
Sole proprietor
No
Enumeration date
Apr 28, 2022
Certification date
Apr 28, 2022
Last updated
Apr 28, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice7543OKYes

Practice location

3703 N Kickapoo Ave
Shawnee, OK 74804-1703

Phone 405-275-0640 · Fax 405-225-3008

Mailing address

400 Riverwalk Ter Ste 250
Jenks, OK 74037-5619

Phone 918-998-0996 · Fax 918-235-9079

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