Individual
DR. TRACY C. BENTON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1310 S RANGE AVE, DENHAM SPRINGS, LA 70726-4810
(225) 664-0040
(225) 664-0042
Mailing address
PO BOX 952, DENHAM SPRINGS, LA 70727-0952
(225) 664-0040
(225) 664-0042
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
03/03/2014
Last updated
03/03/2014
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