Individual
OLIVER BENTON IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
140 KIMEL PARK DR STE 100, WINSTON SALEM, NC 27103-6185
(336) 245-2100
(336) 768-7782
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
2022-01826
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
TN
Other
Enumeration date
05/11/2017
Last updated
03/23/2023
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