Provider Demographics
NPI:1053146829
Name:BENNETT, IULIIA VITALYEVNA (DDS)
Entity type:Individual
Prefix:
First Name:IULIIA
Middle Name:VITALYEVNA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 RABANO
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-4962
Mailing Address - Country:US
Mailing Address - Phone:510-707-1126
Mailing Address - Fax:
Practice Address - Street 1:61 RABANO
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-4962
Practice Address - Country:US
Practice Address - Phone:510-707-1126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1104381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice