Provider Demographics
NPI:1497024194
Name:ERIC BENSON DDS LLC
Entity Type:Organization
Organization Name:ERIC BENSON DDS LLC
Other - Org Name:ROC SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:E
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-426-0810
Mailing Address - Street 1:774 ELMGROVE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1318
Mailing Address - Country:US
Mailing Address - Phone:585-426-0810
Mailing Address - Fax:585-426-0479
Practice Address - Street 1:774 ELMGROVE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1318
Practice Address - Country:US
Practice Address - Phone:585-426-0810
Practice Address - Fax:585-426-0479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-26
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0481271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty