Provider Demographics
NPI:1588868467
Name:HOUSTON, MARY BENNETT (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:BENNETT
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8218 WILKERSON RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:27231-9318
Mailing Address - Country:US
Mailing Address - Phone:919-644-0129
Mailing Address - Fax:
Practice Address - Street 1:415 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-5527
Practice Address - Country:US
Practice Address - Phone:336-599-4145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC56031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice