Provider Demographics
NPI:1326099458
Name:BENSON, KENNETH J (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
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 1:7401 CREEDMOOR RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1640
Mailing Address - Country:US
Mailing Address - Phone:919-622-2035
Mailing Address - Fax:919-846-3550
Practice Address - Street 1:7401 CREEDMOOR RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1640
Practice Address - Country:US
Practice Address - Phone:919-622-2035
Practice Address - Fax:919-846-3550
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6621OtherDELTA DENTAL
NC89022VTMedicaid
NC902VTOtherBCBSNC
NC902VTOtherBCBSNC
NCU90245Medicare UPIN