Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 12218 | NC |
Y | 1223D0001X | Dental Public Health | 12218 | NC |
N | 1223G0001X | General Practice | 12218 | NC |
N | 213EG0000X | General Practice | 12218 | NC |
NPI | 1376112433 |
---|---|
Provider Name | Dr. Breanna Marjorie Benbow |
First Address | Whiteville, NC 28472-0810 |
Second Address | Whiteville, NC 28472-3602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2021 |
Last Update Date | 23/06/2021 |