Provider Demographics
NPI:1356432868
Name:BENTON, JOHN B JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:BENTON
Suffix:JR
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 1:1703 LEIGHTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207
Mailing Address - Country:US
Mailing Address - Phone:256-237-1537
Mailing Address - Fax:256-235-3994
Practice Address - Street 1:1703 LEIGHTON AVENUE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207
Practice Address - Country:US
Practice Address - Phone:256-237-1537
Practice Address - Fax:256-235-3994
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0304Medicare UPIN