Organization
DR TRACY C BENTON DDS APDC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACY CLARK BENTON JR. DDS (PRESIDENT)
(225) 664-0040
Entity
Organization
Contact information
Practice address
1310 SOUTH RANGE AVE, DENHAM SPRINGS, LA 70726
(225) 664-0040
Mailing address
PO BOX 952, DENHAM SPRINGS, LA 70727-0952
(225) 664-0040
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3057
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1830577
—
LA
Enumeration date
02/05/2007
Last updated
02/25/2014
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