Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 126800000X | Dental Assistant | 201692 | IL |
Y | 126800000X | Dental Assistant | EFDA-01263 | OH |
NPI | 1346572252 |
---|---|
Provider Name | Ms. Jennifer Jean Bennett |
First Address | Columbus, OH 43232-5974 |
Second Address | Columbus, OH 43232-5974 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2010 |
Last Update Date | 02/02/2010 |