Provider Demographics
NPI:1912192949
Name:NERO, BENJAMIN WILLIAMSON SR (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:WILLIAMSON
Last Name:NERO
Suffix:SR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 896
Mailing Address - Street 2:DENTAL SUITE
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19004
Mailing Address - Country:US
Mailing Address - Phone:215-473-3543
Mailing Address - Fax:215-473-3872
Practice Address - Street 1:4401 CONSHOHOCKEN AVE
Practice Address - Street 2:DENTAL SUITE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131
Practice Address - Country:US
Practice Address - Phone:215-473-3543
Practice Address - Fax:215-473-3872
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS016781L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics