Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 019025055 | IL |
NPI | 1073774816 |
---|---|
Provider Name | Dr. Brooke Denise Benson |
First Address | Chicago, IL 60607-4350 |
Second Address | Chicago, IL 60607-4350 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2008 |
Last Update Date | 24/06/2008 |