Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 5889917-9924 | UT |
NPI | 1275531584 |
---|---|
Provider Name | Paul Benson |
First Address | Layton, UT 84041-5633 |
Second Address | Layton, UT 84041-5633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 08/07/2007 |