Provider Demographics
NPI:1811909427
Name:BENNETT, WILLIAM P (DDS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
Last Name:BENNETT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-2031
Mailing Address - Country:US
Mailing Address - Phone:304-269-3723
Mailing Address - Fax:304-269-3723
Practice Address - Street 1:324 CENTER AVE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-2031
Practice Address - Country:US
Practice Address - Phone:304-269-3723
Practice Address - Fax:304-269-3723
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0134732000Medicaid