Provider Demographics
NPI:1881627750
Name:KOREN, BENJAMIN (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:KOREN
Suffix:
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 1:8120 LLOYD ALLYNS WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4930
Mailing Address - Country:US
Mailing Address - Phone:919-676-2123
Mailing Address - Fax:
Practice Address - Street 1:910 S BRIGHTLEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4388
Practice Address - Country:US
Practice Address - Phone:919-934-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89016HPMedicaid
NC89902CAMedicaid
NC902TUOtherBLUE CROSS & BLUE SHIELD