Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN 11562 | FL |
NPI | 1013030469 |
---|---|
Provider Name | Dr. Raymond Sanford Benson JR. |
First Address | Vero Beach, FL 32962-4703 |
Second Address | Vero Beach, FL 32962-4703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 08/07/2007 |