Provider Demographics
NPI:1417398280
Name:BENSON, KENNETH C (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:C
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 1:12318 SLEEPING BEAR RD
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-7091
Mailing Address - Country:US
Mailing Address - Phone:208-520-3735
Mailing Address - Fax:
Practice Address - Street 1:9625 PROMINENT PT
Practice Address - Street 2:STE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-5004
Practice Address - Country:US
Practice Address - Phone:719-495-5748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4508122300000X
CODEN.00202199122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist