Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 8121 | TX |
NPI | 1003176959 |
---|---|
Provider Name | Benedict Eric Homer |
First Address | Garland, TX 75042 |
Second Address | Garland, TX 75042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2012 |
Last Update Date | 25/05/2012 |