Provider Demographics
NPI:1962167809
Name:ADAM BENNETT LLC
Entity type:Organization
Organization Name:ADAM BENNETT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-577-7286
Mailing Address - Street 1:278 DANDY WAY
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-8666
Mailing Address - Country:US
Mailing Address - Phone:870-577-7286
Mailing Address - Fax:
Practice Address - Street 1:168 S PAYNE STEWART DR STE 100
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2718
Practice Address - Country:US
Practice Address - Phone:417-263-3127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-04
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental