Provider Demographics
NPI:1164513057
Name:BENSON, GERALD MITCHELL (DDS)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:MITCHELL
Last Name:BENSON
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 1:5010 PAULSEN ST
Mailing Address - Street 2:STE #1
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-351-0081
Mailing Address - Fax:912-351-0647
Practice Address - Street 1:5010 PAULSEN ST
Practice Address - Street 2:STE #1
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:912-351-0081
Practice Address - Fax:912-351-0647
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA7688122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist