Provider Demographics
NPI:1467964858
Name:DAVID ANDREW BENSON, DDS, PLLC
Entity Type:Organization
Organization Name:DAVID ANDREW BENSON, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:318-426-0379
Mailing Address - Street 1:111 LABELLE LN
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2964
Mailing Address - Country:US
Mailing Address - Phone:318-426-0379
Mailing Address - Fax:
Practice Address - Street 1:6160 TUTT BLVD STE 250
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-1500
Practice Address - Country:US
Practice Address - Phone:719-359-8652
Practice Address - Fax:719-623-5771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002033291223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty