Provider Demographics
NPI:1356722771
Name:BENNER, ALEXANDER (DMD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:BENNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 BROOKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-9126
Mailing Address - Country:US
Mailing Address - Phone:717-258-5455
Mailing Address - Fax:
Practice Address - Street 1:49 BROOKWOOD AVE
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-9126
Practice Address - Country:US
Practice Address - Phone:717-258-5455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040418122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist