Provider Demographics
NPI:1497527527
Name:MARK P. BENNER, D.D.S., P.C.
Entity Type:Organization
Organization Name:MARK P. BENNER, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PAYOR CONTRACTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-732-1504
Mailing Address - Street 1:212 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-2202
Mailing Address - Country:US
Mailing Address - Phone:770-867-3275
Mailing Address - Fax:770-586-5718
Practice Address - Street 1:212 E BROAD ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-2202
Practice Address - Country:US
Practice Address - Phone:770-867-3275
Practice Address - Fax:770-586-5718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental