Provider Demographics
NPI:1720397987
Name:NEAL R. BENHAM D.D.S.,S.C.
Entity Type:Organization
Organization Name:NEAL R. BENHAM D.D.S.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR.
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ENGEDAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-835-7172
Mailing Address - Street 1:3131 STEIN BLVD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6997
Mailing Address - Country:US
Mailing Address - Phone:715-835-7172
Mailing Address - Fax:715-835-5841
Practice Address - Street 1:3131 STEIN BLVD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6997
Practice Address - Country:US
Practice Address - Phone:715-835-7172
Practice Address - Fax:715-835-5841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty