Provider Demographics
NPI:1851501696
Name:BENNER, DAWN B (CPO,CPED)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:B
Last Name:BENNER
Suffix:
Gender:F
Credentials:CPO,CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:NC
Mailing Address - Zip Code:28399-0250
Mailing Address - Country:US
Mailing Address - Phone:910-299-0100
Mailing Address - Fax:910-299-0101
Practice Address - Street 1:218 LISBON ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-4115
Practice Address - Country:US
Practice Address - Phone:910-299-0100
Practice Address - Fax:910-299-0101
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795159Medicaid