Provider Demographics
NPI:1063284123
Name:BENJAMIN KOREN, DDS VI PA
Entity type:Organization
Organization Name:BENJAMIN KOREN, DDS VI PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROESCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-978-9800
Mailing Address - Street 1:117 VILLAGE RD NE STE H
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-3900
Mailing Address - Country:US
Mailing Address - Phone:910-371-5664
Mailing Address - Fax:
Practice Address - Street 1:117 VILLAGE RD NE STE H
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-3900
Practice Address - Country:US
Practice Address - Phone:910-371-5664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty