Healthcare Provider Details

I. General information

NPI: 1720397987
Provider Name (Legal Business Name): NEAL R. BENHAM D.D.S.,S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 STEIN BLVD
EAU CLAIRE WI
54701-6997
US

IV. Provider business mailing address

3131 STEIN BLVD
EAU CLAIRE WI
54701-6997
US

V. Phone/Fax

Practice location:
  • Phone: 715-835-7172
  • Fax: 715-835-5841
Mailing address:
  • Phone: 715-835-7172
  • Fax: 715-835-5841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MS. SHELLEY M ENGEDAL
Title or Position: OFFICE MGR.
Credential:
Phone: 715-835-7172