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JR BENNETT DMD
NPI 1669260113
Student in an Organized Health Care Education/Training Program in San Diego, CA

Active since April 25, 2025
4060 FAIRMOUNT AVE, SAN DIEGO, CA 92105(619) 280-4213 Get Directions Write a Review

NPPES record last updated: April 25, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jr Bennett Dmd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JR BENNETT DMD (NPI 1669260113) is an individual student in an organized health care education/training program in San Diego, California and active in the NPI registry since April 2025.

NPPES Registry Identity

NPI1669260113
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameJR BENNETTCredential: DMD
Location Address4060 FAIRMOUNT AVESan Diego, CA 92105-1608
Mailing Address410 Center Green DrLas Vegas, NV 89148-5222 · (702) 526-1502
Phone(619) 280-4213
Sole ProprietorYes
Enumeration DateApril 25, 2025
NPPES CertifiedApril 25, 2025
✔ NPI 1669260113 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
4060 FAIRMOUNT AVE, San Diego, CA 92105
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. DORA DOAN O.D.
Optometrist
4060 FAIRMOUNT AVE, OPTOMETRY DEPARTMENT
SAN DIEGO, CA 92105
San Diego County (619) 961-0803
DIANA P ALVAREZ MSW
Counselor (Mental Health)
4060 FAIRMOUNT AVE
SAN DIEGO, CA 92105
San Diego County (619) 295-6047
KALEELAH RAE, NAJA MUHAMMAD
Student in an Organized Health Care Education/Training Program
4060 FAIRMOUNT AVE
SAN DIEGO, CA 92105
San Diego County (619) 280-4213
DR. ADLA TESSIER M.D.
Internal Medicine
4060 FAIRMOUNT AVE, FAMILY PRACTICE
SAN DIEGO, CA 92105
San Diego County (619) 255-9155
CYNTHIA MIRANDA PSYD
Psychologist
4060 FAIRMOUNT AVE
SAN DIEGO, CA 92105
San Diego County (619) 564-8765
TONYA DANIELLE DANIEL LCSW
Social Worker (Clinical)
4060 FAIRMOUNT AVE
SAN DIEGO, CA 92105
San Diego County (619) 584-1612
SAMANTHA GOGGIN MD
Pediatrics
4060 FAIRMOUNT AVE, PEDIATRICS DEPARTMENT
SAN DIEGO, CA 92105
San Diego County (619) 255-9154
NYAKOACH LAM ACSW
Social Worker
4060 FAIRMOUNT AVE
SAN DIEGO, CA 92105
San Diego County (619) 285-7097

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jr Bennett's NPI number?

The NPI number for Jr Bennett is 1669260113. It was assigned to this individual provider in the NPPES registry on April 25, 2025.

Where is Jr Bennett located?

Jr Bennett practices at 4060 Fairmount Ave, San Diego, CA 92105. The listed phone number is (619) 280-4213.

What is Jr Bennett's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Jr Bennett was last updated on April 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.