Individual
BROCK BENNION
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
104 S OLD BETSY RD, KEENE, TX 76059-2425
(817) 641-2272
Mailing address
104 S OLD BETSY RD, KEENE, TX 76059-2425
(817) 641-2272
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
12269263-9923
UT
1223G0001X
General Practice Dentistry
Primary
37274
TX
Other
Enumeration date
05/28/2021
Last updated
11/09/2021
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