Provider Demographics
NPI:1043224637
Name:BENOIT, JASON R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:R
Last Name:BENOIT
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 1:3024 VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-2793
Mailing Address - Country:US
Mailing Address - Phone:563-332-2447
Mailing Address - Fax:563-332-9787
Practice Address - Street 1:3024 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-2793
Practice Address - Country:US
Practice Address - Phone:563-332-2447
Practice Address - Fax:563-332-9787
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1308450OtherUNITED CONCORDIA
IA43077OtherBCBS
IA1188102Medicaid