Individual
BROCK BENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3999 N GLOSTER ST STE D, TUPELO, MS 38804-0950
(662) 778-2002
Mailing address
42014 CAMINO CASANA, TEMECULA, CA 92592-6359
(951) 719-7173
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4447-24
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/14/2024
Last updated
06/12/2024
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