Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 12011502A | IN |
Y | 1223P0300X | Periodontist | DE60402132 | WA |
NPI | 1003258641 |
---|---|
Provider Name | Dr. Duane Everett Bennett II |
First Address | Silver Spring, MD 20901-1563 |
Second Address | Silver Spring, MD 20901-1563 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2013 |
Last Update Date | 28/01/2022 |