Healthcare Provider Details

I. General information

NPI: 1881075984
Provider Name (Legal Business Name): BRENT JOSEPH BENOIT D.D.S., M.S.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 ENTERPRISE DR
HOUMA LA
70360-5405
US

IV. Provider business mailing address

635 ENTERPRISE DR
HOUMA LA
70360-5405
US

V. Phone/Fax

Practice location:
  • Phone: 985-853-1142
  • Fax:
Mailing address:
  • Phone: 985-853-1142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6551
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6551
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: