Provider Demographics
NPI:1376540450
Name:BENJAMIN, SCOTT D (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:BENJAMIN
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 1:1863 CRYSTAL LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:NY
Mailing Address - Zip Code:13783-1915
Mailing Address - Country:US
Mailing Address - Phone:607-467-4456
Mailing Address - Fax:607-467-5634
Practice Address - Street 1:60 UNION ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-1430
Practice Address - Country:US
Practice Address - Phone:607-563-2333
Practice Address - Fax:607-563-8946
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0338781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00575475Medicaid
NYU99906Medicare UPIN
NYDE7331Medicare PIN