Active NPI
Mary T Benjamin, DDS
- Public Health Dentistry
- Lawrenceville, GA
National Provider Identifier
1790743870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Public Health Dentistry
- License
- DN010144
- Practice address
- 15 S Clayton St
Lawrenceville, GA 30045-5715 - Phone
- (770) 339-4283
- Fax
- (770) 279-5983
- NPI assigned
- May 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health Dentistry | 1223D0001X | DN010144 | GA | Primary |
Addresses
Primary practice location
15 S Clayton St
Lawrenceville, GA 30045-5715
Mailing address
PO Box 897
2570 Riverside Parkway
Lawrenceville, GA 30046-0897
Phone (770) 339-4260
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN010144 | GA | MD | Public Health Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790743870",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 897",
"address_2": "2570 RIVERSIDE PARKWAY",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300460897",
"telephone_number": "770-339-4260",
"fax_number": "770-963-6322"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 S CLAYTON ST",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300455715",
"telephone_number": "770-339-4283",
"fax_number": "770-279-5983"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENJAMIN",
"first_name": "MARY",
"middle_name": "T",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223D0001X",
"taxonomy_group": "",
"desc": "Dentist, Dental Public Health",
"state": "GA",
"license": "DN010144",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lawrenceville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.