Provider Demographics
NPI:1235167073
Name:BENJAMIN KOREN, D.D.S. II. P.A,
Entity Type:Organization
Organization Name:BENJAMIN KOREN, D.D.S. II. P.A,
Other - Org Name:HENDERSON FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:KOREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-438-7384
Mailing Address - Street 1:560 DABNEY DRIVE, SUITE C
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536
Mailing Address - Country:US
Mailing Address - Phone:919-528-4004
Mailing Address - Fax:
Practice Address - Street 1:560 DABNEY DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-3946
Practice Address - Country:US
Practice Address - Phone:252-438-7384
Practice Address - Fax:252-492-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6997122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017JXOtherBCBS GROUP NUMBER
NC5901684Medicaid