Provider Demographics
NPI:1851474548
Name:BENEFIELD, RANDAL MAXWELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:MAXWELL
Last Name:BENEFIELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7718 SIX FORKS RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5071
Mailing Address - Country:US
Mailing Address - Phone:919-676-4749
Mailing Address - Fax:919-676-6635
Practice Address - Street 1:7718 SIX FORKS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5071
Practice Address - Country:US
Practice Address - Phone:919-676-4749
Practice Address - Fax:919-676-6635
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC56951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice