Provider Demographics
NPI:1730185570
Name:BENNETT, DUDLEY E (DO)
Entity type:Individual
Prefix:DR
First Name:DUDLEY
Middle Name:E
Last Name:BENNETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3655
Mailing Address - Country:US
Mailing Address - Phone:401-467-6257
Mailing Address - Fax:401-785-1191
Practice Address - Street 1:1050 WARWICK AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3655
Practice Address - Country:US
Practice Address - Phone:401-467-6257
Practice Address - Fax:401-785-1191
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00294207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003606Medicaid
RI9003606Medicaid
C89695Medicare UPIN