Dr. Mark Richard Benne, DDS
Dentist, General Practice in Fort Campbell, KY. Individual provider (NPI-1).
NPI number1104806041
StatusActive
Last updated in NPPESJul 21, 2022
Details
- NPI
- 1104806041
- Entity type
- Individual (NPI-1)
- Name
- Dr. Mark Richard Benne
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jan 18, 2006
- Last updated
- Jul 21, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | DE00007213 | WA | Yes |
| 1223G0001X | Dentist, General Practice | 019.019810 | IL | |
| 1223G0001X | Dentist, General Practice | 16-0000997 | VT | |
| 1223G0001X | Dentist, General Practice | DEN.00007213 | CO | |
| 1223G0001X | Dentist, General Practice | 53740 | CA |
Practice location
2441 21st StFort Campbell, KY 42223-5582
Phone 270-798-8977
Mailing address
2441 21st StFort Campbell, KY 42223-5582
Phone 270-798-8977
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