Provider Demographics
NPI:1902043292
Name:BENJAMIN KOREN, D.D.S. V, P.A.
Entity Type:Organization
Organization Name:BENJAMIN KOREN, D.D.S. V, P.A.
Other - Org Name:TOTAL SMILES OF ROXBORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CORBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-528-0800
Mailing Address - Street 1:4112 PLEASANT VALLEY RD STE 212
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2634
Mailing Address - Country:US
Mailing Address - Phone:919-528-0800
Mailing Address - Fax:888-818-4195
Practice Address - Street 1:347 S MADISON BLVD
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-5464
Practice Address - Country:US
Practice Address - Phone:919-528-0800
Practice Address - Fax:888-818-4195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty