Provider Demographics
NPI:1427336312
Name:DEHART, BENJAMIN EDWARD (DMD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:EDWARD
Last Name:DEHART
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 F S HILL DR
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-5003
Mailing Address - Country:US
Mailing Address - Phone:662-226-6607
Mailing Address - Fax:
Practice Address - Street 1:1825 F S HILL DR
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-5003
Practice Address - Country:US
Practice Address - Phone:662-226-6607
Practice Address - Fax:662-226-6615
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3601-111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice