Provider Demographics
NPI:1730402421
Name:MCCARTY, BENJAMIN SIMON (DMD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:SIMON
Last Name:MCCARTY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 LEXAN AVE STE 187
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-1237
Mailing Address - Country:US
Mailing Address - Phone:757-440-1360
Mailing Address - Fax:757-440-1361
Practice Address - Street 1:1170 LEXAN AVE STE 187
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508
Practice Address - Country:US
Practice Address - Phone:757-440-1360
Practice Address - Fax:757-440-1361
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412463122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist