Provider Demographics
NPI:1245421205
Name:BENHAM, ADAM W (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:W
Last Name:BENHAM
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 LEGACY DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6747
Mailing Address - Country:US
Mailing Address - Phone:214-618-8182
Mailing Address - Fax:214-618-8184
Practice Address - Street 1:8504 BOULDER RIVER TRL
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6111
Practice Address - Country:US
Practice Address - Phone:469-231-6672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2009-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22263122300000X, 1223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189795101Medicaid