MEDICARE: PHILIP LIN BENTON DMD

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	122300000X	Dentist	SC2561	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427032424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP LIN BENTON DMD

Provider Business Mailing Address
First Line	:	103 E TATUM AVE
Second Line	:
City	:	MC COLL
State	:	SC
Zip	:	29570-2323
Country	:	US
Telephone Number	:	843-523-5291
Fax Number	:	843-523-9714

Provider Business Practice Location Address
First Line	:	103 E TATUM AVE
Second Line	:
City	:	MC COLL
State	:	SC
Zip	:	29570-2323
Country	:	US
Telephone Number	:	843-523-5291
Fax Number	:	843-523-9714

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

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	07/09/2007

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Directions to “ PHILIP LIN BENTON DMD” Practice Location

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