Individual
BENTON GERARD WEINACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1136 FOLLY RD, CHARLESTON, SC 29412-4104
(843) 738-1196
Mailing address
5425 SPRINGHILL WOODS DR S, MOBILE, AL 36608-0701
(251) 586-1331
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DGD10599
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/15/2023
Last updated
07/27/2023
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