Provider Demographics
NPI:1124034913
Name:BENS, MICHAEL ALLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALLEN
Last Name:BENS
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 1:1150 HAMMOND DR
Mailing Address - Street 2:BLDG. E, SUITE 225
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5334
Mailing Address - Country:US
Mailing Address - Phone:770-913-0703
Mailing Address - Fax:770-913-0075
Practice Address - Street 1:1150 HAMMOND DR
Practice Address - Street 2:BLDG. E, SUITE 225
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5334
Practice Address - Country:US
Practice Address - Phone:770-913-0703
Practice Address - Fax:770-913-0075
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012194122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA201861022OtherEIN