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General NPI Number Information
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NPI Number | 1093033862
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Entity Type | Individual
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Provider Name | LEWIS SHELLEY BENJAMIN D.M.D., M.S.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2010
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 12156 N.W. 9TH PLACE
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City | CORAL SPRINGS
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State | FL
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Zip | 33071
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Country | US
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Telephone | 954-346-0711
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Fax | 954-346-6960
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Provider Business Mailing Address
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Address Line | 12156 N.W. 9TH PLACE
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City | CORAL SPRINGS
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State | FL
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Zip | 33071
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Country | US
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Telephone | 954-346-0711
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Fax | 954-346-6960
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN7536
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License Number State | FL
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