Provider Demographics
NPI:1568689347
Name:YARBOROUGH, BENJAMIN HALL II (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:HALL
Last Name:YARBOROUGH
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:460 S MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-8006
Mailing Address - Country:US
Mailing Address - Phone:704-892-6602
Mailing Address - Fax:704-896-8792
Practice Address - Street 1:460 S MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-8006
Practice Address - Country:US
Practice Address - Phone:704-892-6602
Practice Address - Fax:704-896-8792
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC44591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8999601Medicaid