Provider Demographics
NPI:1780701821
Name:BENHAM, NEAL R (DDS)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:R
Last Name:BENHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 STEIN BLVD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6997
Mailing Address - Country:US
Mailing Address - Phone:715-835-7172
Mailing Address - Fax:715-835-5841
Practice Address - Street 1:3131 STEIN BLVD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6997
Practice Address - Country:US
Practice Address - Phone:715-835-7172
Practice Address - Fax:715-835-5841
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50008500151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38373400OtherWI MA