Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 6150 | LA |
N | 1223E0200X | Endodontist | DE60364992 | WA |
NPI | 1124462924 |
---|---|
Provider Name | Jeffrey Paul Bennett |
First Address | Seattle, WA 98104-3586 |
Second Address | Seattle, WA 98115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2013 |
Last Update Date | 10/07/2018 |