Provider Demographics
NPI:1760675227
Name:BENSON, WAKESHI LANISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAKESHI
Middle Name:LANISE
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 1:12230 IRON BRIDGE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1534
Mailing Address - Country:US
Mailing Address - Phone:804-454-1888
Mailing Address - Fax:
Practice Address - Street 1:12230 IRON BRIDGE RD
Practice Address - Street 2:SUITE B
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1534
Practice Address - Country:US
Practice Address - Phone:804-454-1888
Practice Address - Fax:804-454-1868
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017909122300000X
VA04014114151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist