Edwin Roland Bennett IV, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

107244 Issued in CA

Practice address

300 E Yorba Linda Blvd Ste E
Placentia, CA 92870-2910

Phone

(714) 524-0207

NPI assigned

Aug 24, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bennett and Harbach Dental Corporation

  • General Practice Dentistry
  • Placentia, CA
  • NPI 1083443451
  NPD Authorized official
• David Alley DDS Apc

  • General Practice Dentistry
  • Placentia, CA
  • NPI 1598980401
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739145600000",
    "number": "1013520766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E YORBA LINDA BLVD STE E",
            "city": "PLACENTIA",
            "state": "CA",
            "postal_code": "928702910",
            "telephone_number": "714-524-0207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E YORBA LINDA BLVD STE E",
            "city": "PLACENTIA",
            "state": "CA",
            "postal_code": "928702910",
            "telephone_number": "714-524-0207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "EDWIN",
        "middle_name": "ROLAND",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-24",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D11299",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "107244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristian Beltran Montoya
• Erika Michelle Beltran
• Erica Benavides-Arias, FNP-BC
• Jacob Benitez
• Bennett and Harbach Dental Corporation
• Berkeley Psychological Services
• Nicole M Bertucci, LMFT
• Karyn Taylor Best
• Beverly Oncology & Imaging Center Medical GR
• Deep Bhavsar III, MS, ATC

• Dentist in Placentia, CA
• Providers in Placentia, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.