Provider Demographics
NPI:1235349028
Name:BENSON, STEVEN JON (DMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JON
Last Name:BENSON
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 1:405 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-5007
Mailing Address - Country:US
Mailing Address - Phone:716-664-4065
Mailing Address - Fax:716-664-4065
Practice Address - Street 1:405 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5007
Practice Address - Country:US
Practice Address - Phone:716-664-4065
Practice Address - Fax:716-664-4065
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031766122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist