Provider Demographics
NPI:1457560856
Name:BENJAMIN, NEVILLE (DDS, MSCD)
Entity type:Individual
Prefix:DR
First Name:NEVILLE
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:DDS, MSCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 COLUMBIA DR
Mailing Address - Street 2:SUITE D 101
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-1997
Mailing Address - Country:US
Mailing Address - Phone:561-640-9200
Mailing Address - Fax:561-640-9204
Practice Address - Street 1:470 COLUMBIA DR
Practice Address - Street 2:SUITE D 101
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1997
Practice Address - Country:US
Practice Address - Phone:561-640-9200
Practice Address - Fax:561-640-9204
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL95451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice