Provider Demographics
NPI:1154994887
Name:BENNETT, BRANDEN (DMD)
Entity type:Individual
Prefix:DR
First Name:BRANDEN
Middle Name:
Last Name:BENNETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0S993 THORNDON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ELBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60119-9653
Mailing Address - Country:US
Mailing Address - Phone:815-252-8133
Mailing Address - Fax:
Practice Address - Street 1:26 CROSS CT
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-5485
Practice Address - Country:US
Practice Address - Phone:630-466-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0347721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice