Active NPI
Mac Leon Bennett III, DDS
- General Practice Dentistry
- Madisonville, TX
National Provider Identifier
1407968803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8253
- Practice address
- 714 B South Madison
Madisonville, TX 77864 - Phone
- (936) 348-5158
- Fax
- (936) 348-5622
- NPI assigned
- Aug 31, 2006
- Last updated
- Jun 19, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8253 | TX | Primary |
Addresses
Primary practice location
714 B South Madison
Madisonville, TX 77864
Mailing address
PO Box 100
Madisonville, TX 77864
Phone (936) 348-5158
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G6025601 | Other | TX | TEXAS CHIP |
| 008028501 | Medicaid | TX | |
| 86D579 | Other | TX | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8253 | TX | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mac L Bennett III DDS Inc | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Madisonville, TX
- NPI 1457463820
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213833600000",
"number": "1407968803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 100",
"city": "MADISONVILLE",
"state": "TX",
"postal_code": "77864",
"telephone_number": "936-348-5158",
"fax_number": "936-348-5622"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "714 B SOUTH MADISON",
"city": "MADISONVILLE",
"state": "TX",
"postal_code": "77864",
"telephone_number": "936-348-5158",
"fax_number": "936-348-5622"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "MAC",
"middle_name": "LEON",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2008-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "8253",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEXAS CHIP",
"identifier": "G6025601",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008028501",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "86D579",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Madisonville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.