Provider Demographics
NPI:1467656983
Name:BENSON, MARY PRESTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:PRESTON
Last Name:BENSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18000 W 82ND ST
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-2157
Mailing Address - Country:US
Mailing Address - Phone:952-975-9517
Mailing Address - Fax:
Practice Address - Street 1:1 GENERAL MILLS BLVD
Practice Address - Street 2:HEALTH SERVICES DEPT.
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55426-1347
Practice Address - Country:US
Practice Address - Phone:763-764-3952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10226122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist