MEDICARE: BENJAMIN MCCARTY DMD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1699244210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENJAMIN MCCARTY DMD PLLC

Provider Business Mailing Address
First Line	:	1170 LEXAN AVE STE 187
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23508-1237
Country	:	US
Telephone Number	:	757-440-1360
Fax Number	:

Provider Business Practice Location Address
First Line	:	1170 LEXAN AVE STE 187
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23508-1237
Country	:	US
Telephone Number	:	757-440-1360
Fax Number	:	757-440-1361

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. BENJAMIN SIMON MCCARTY
Credential	:	DMD
Telephone Number	:	757-440-1360

Provider Enumeration Date	:	11/14/2018
Last Update Date	:	11/14/2018

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