MEDICARE: DR. PARKER NASH BENTON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2019019704	MO

General Provider Information

NPI Number	:	1346895596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PARKER NASH BENTON DDS

Provider Business Mailing Address
First Line	:	2901 CASSIDY RD
Second Line	:
City	:	FORT BLISS
State	:	TX
Zip	:	79916-3502
Country	:	US
Telephone Number	:	915-742-5935
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 CASSIDY RD
Second Line	:
City	:	FORT BLISS
State	:	TX
Zip	:	79916-3502
Country	:	US
Telephone Number	:	915-742-5935
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2019
Last Update Date	:	08/20/2020

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