1003280124 NPI number — DR. HAYWARD BENTON DRANE IV DMD

Table of content: DR. HAYWARD BENTON DRANE IV DMD (NPI 1003280124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003280124 NPI number — DR. HAYWARD BENTON DRANE IV DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRANE
Provider First Name:
HAYWARD
Provider Middle Name:
BENTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
IV
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHRISTIE
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1003280124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 CHESLEY DRIVE
Provider Second Line Business Mailing Address:
CLUSTERS UNIT
Provider Business Mailing Address City Name:
MEDIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-566-6649
Provider Business Mailing Address Fax Number:
610-566-6740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CHESLEY DRIVE
Provider Second Line Business Practice Location Address:
CLUSTERS UNIT
Provider Business Practice Location Address City Name:
MEDIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-566-6649
Provider Business Practice Location Address Fax Number:
610-566-6740
Provider Enumeration Date:
12/01/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  DS039262 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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