Brandon Keith Bennett, D.D.S.
Individual provider Active NPI General Practice Dentistry · Eldon, MO
NPI 1609017490 · NPPES record last updated Sep 5, 2013
Key facts
- NPI
- 1609017490
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 2009013178 (MO)
- Practice address
- 202 N Maple St
Eldon, MO 65026-1776 - Phone
- (573) 392-5213
- Fax
- (573) 392-5213
- NPI assigned
- Mar 9, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181130000622 | MO | Order and Referring Only - Dentist |
8123362233 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2009013178 | MO | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brandon K Bennett DDS LLC | Current |
Accepting new patients |
Locations
202 N Maple St
Eldon, MO 65026
Phone (573) 392-5213
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2009013178 | MO | Yes |
Addresses
Primary practice location
202 N Maple St
Eldon, MO 65026-1776
Mailing address
23 Mockingbird Rd
Lake Ozark, MO 65049-7108
Phone (314) 704-0881
Other providers in Eldon, MO
- Kayla Allison
- Richard Mark Anderegg
- Apothecare Health Services
- Evgeniya Banina
- BC King DDS PC
- Paul Bernabe
- Jeanell Bertels
- Kayla Jean Blaes
- Henry Keiler Bluhm Jr.
- Megan Boehmer
All providers in Eldon, MO · General Practice Dentistry in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 5, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.