Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 23432 | TX |
NPI | 1003064056 |
---|---|
Provider Name | Nicole L Benson |
First Address | Dallas, TX 75243-8216 |
Second Address | Dallas, TX 75243-8216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2008 |
Last Update Date | 03/09/2008 |