Provider Demographics
NPI:1184648214
Name:BENCIE, NICHOLAS (DMD, FAGD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:BENCIE
Suffix:
Gender:M
Credentials:DMD, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 S BREWSTER RD
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-7801
Mailing Address - Country:US
Mailing Address - Phone:856-692-0060
Mailing Address - Fax:856-692-0382
Practice Address - Street 1:630 S BREWSTER RD
Practice Address - Street 2:SUITE A-2
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-7801
Practice Address - Country:US
Practice Address - Phone:856-692-0060
Practice Address - Fax:856-692-0382
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1016492001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA182501OtherUNITED CONCORDIA
NJ16492OtherDELTA DENTAL