Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | PENDING | MD |
NPI | 1003044603 |
---|---|
Provider Name | Dr. Nicholas Sewell Bennett |
First Address | Baltimore, MD 21201-1524 |
Second Address | Baltimore, MD 21201-1524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2009 |
Last Update Date | 23/06/2009 |