Healthcare Provider Details

I. General information

NPI: 1750696910
Provider Name (Legal Business Name): BENJAMIN KOREN, DDS VI PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117H VILLAGE RD NE
LELAND NC
28451-7413
US

IV. Provider business mailing address

117 VILLAGE RD NE STE H
LELAND NC
28451-3900
US

V. Phone/Fax

Practice location:
  • Phone: 919-528-0800
  • Fax: 888-818-4195
Mailing address:
  • Phone: 910-371-5664
  • Fax: 888-818-4195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: AMANDA GROESCHEL
Title or Position: DIRECTOR
Credential:
Phone: 704-978-9800