Healthcare Provider Details

I. General information

NPI: 1376736041
Provider Name (Legal Business Name): JENNIFER BENCH R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305TH DENTAL SQUADRON BLDG. 2417 MCGUIRE BLVD.
MCGUIRE AFB NJ
08641
US

IV. Provider business mailing address

7 SCHENK PL
ROBBINSVILLE NJ
08691-1145
US

V. Phone/Fax

Practice location:
  • Phone: 609-754-3786
  • Fax:
Mailing address:
  • Phone: 609-223-0179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number22HI00494800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: