Christian Michael Bennett, DMD
Individual provider Active NPI General Practice Dentistry · Vine Grove, KY
NPI 1982220992 · NPPES record last updated Sep 1, 2020
Key facts
- NPI
- 1982220992
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 10516 (KY)
- Practice address
- 201 W Main St
Vine Grove, KY 40175-1304 - Phone
- (270) 877-2011
- Fax
- (270) 877-8553
- NPI assigned
- Jun 25, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10516 | KY | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Main Street Dental, LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| General Practice Dentistry | 1223G0001X | 10516 | KY | Yes |
Addresses
Primary practice location
201 W Main St
Vine Grove, KY 40175-1304
Mailing address
822 N Elm St
Henderson, KY 42420-2709
Phone (270) 826-8899
Other practice location 1
822 N Elm St
Henderson, KY 42420-2709
Phone (270) 826-8899
Other providers in Vine Grove, KY
- Shelley Kaye Adkins
- Apothecare Pharmacy of Elizabethtown P S C
- Marissa Nicole Ash
- Lisa K Babb
- Michael Anthony Bell
- Thomas R. Bennett
- Jeremy David Bewley
- Jaidyn Bow
- Victoria Erin Bradley
- Gregory H Brandenburg
All providers in Vine Grove, KY · General Practice Dentistry in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 1, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.