Individual
DR. GAIL V BENTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
4463 N STATE ST, JACKSON, MS 39206
(601) 714-2908
Mailing address
4463 N STATE ST, JACKSON, MS 39206
(601) 714-2908
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
3521-09
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1846066
—
LA
01
—
3521-09
DENTAL LICENSE
MS
05
—
9907750
—
MS
Enumeration date
08/16/2005
Last updated
10/10/2016
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