Lathonia Bennett, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

3809 Issued in SC

Practice address

PO Box 1010
Kingstree, SC 29556-1010

Phone

(843) 800-0087

Fax

(866) 379-9998

NPI assigned

Apr 9, 2007

Sex

Female

Sole proprietor

Yes

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.

• Justus Dental Health and Wellness

  • Dental Clinic/Center
  • Andrews, SC
  • NPI 1538879648
  NPD Authorized official
• Justus Dental, Health and Wellness

  • Community Health Clinic/Center
  • Andrews, SC
  • NPI 1275308207

  General Practice

  NPD Authorized official
• Georgia Dental Professionals, PC

  • General Practice Dentistry
  • Brunswick, GA
  • NPI 1124576954

  General Practice

  NPD (past)
• McKinney Community Health Ctr, Inc

  • Federally Qualified Health Center (FQHC)
  • Blackshear, GA
  • NPI 1568623346
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 24, 2024.

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713916800000",
    "number": "1457474124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1010",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "295561010",
            "telephone_number": "912-996-3303",
            "fax_number": "866-379-9998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 1010",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "295561010",
            "telephone_number": "843-800-0087",
            "fax_number": "866-379-9998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "LATHONIA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-09",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "25317",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "3809",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "12503",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "3809",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "SC",
            "license": "3809",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy McClary Ard, MCD
• Ash-Court Companion Care
• Rachael Atkinson
• Bailey Transportation LLC
• Baybay'S Help
• Bio-Medical Applications of South Carolina, Inc.
• Black River Healthcare, Inc.
• Black River Healthcare, Inc.
• Black River Medical Supplies and Equipment, LLC
• Black River Pharmacy LLC

• All providers in Kingstree, SC
• Dentist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; 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.