Individual
MISS SHANNON TRENAY BENJAMIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1067 TWINING DR, BARKSDALE AFB, LA 71110-2486
(318) 456-6775
Mailing address
4147 CALDERWOOD DR, SHREVEPORT, LA 71119-7623
(318) 456-6775
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
4022
LA
Other
Enumeration date
10/21/2008
Last updated
10/21/2008
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