Provider Demographics
NPI:1235210303
Name:BENSON, GERALD MITCHELL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:MITCHELL
Last Name:BENSON
Suffix:JR
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:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4504
Mailing Address - Country:US
Mailing Address - Phone:912-351-0081
Mailing Address - Fax:
Practice Address - Street 1:5010 PAULSEN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4504
Practice Address - Country:US
Practice Address - Phone:912-351-0081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADPH0000031223D0001X
GADN0136341223G0001X
NC82091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health