Provider Demographics
NPI:1669464962
Name:BENSON, BRADY E (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADY
Middle Name:E
Last Name:BENSON
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 1:111 E FOREST ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-2127
Mailing Address - Country:US
Mailing Address - Phone:435-723-2318
Mailing Address - Fax:435-723-3684
Practice Address - Street 1:111 E FOREST ST
Practice Address - Street 2:SUITE F
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-2127
Practice Address - Country:US
Practice Address - Phone:435-723-2318
Practice Address - Fax:435-723-3684
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-3756122300000X
UT6213980-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist