Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 19344 | TX |
NPI | 1093865487 |
---|---|
Provider Name | Dr. Benjamin Sanders Meyrat |
First Address | Conover, NC 28613 |
Second Address | Conover, NC 28613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 15/08/2018 |