Provider Demographics
NPI:1164611463
Name:DANIEL, BENGE ROBERT JR (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BENGE
Middle Name:ROBERT
Last Name:DANIEL
Suffix:JR
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 HULEN ST
Mailing Address - Street 2:SUITE C-4
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6863
Mailing Address - Country:US
Mailing Address - Phone:817-737-2594
Mailing Address - Fax:817-732-4718
Practice Address - Street 1:3600 HULEN ST
Practice Address - Street 2:SUITE C-4
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6863
Practice Address - Country:US
Practice Address - Phone:817-737-2594
Practice Address - Fax:817-732-4718
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113431223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics