Provider Demographics
NPI:1841429131
Name:BENSON, AMY BUCKLEY (RDH, MAOM)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:BUCKLEY
Last Name:BENSON
Suffix:
Gender:F
Credentials:RDH, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-2622
Mailing Address - Country:US
Mailing Address - Phone:508-279-1366
Mailing Address - Fax:
Practice Address - Street 1:509 SUMMER ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-2622
Practice Address - Country:US
Practice Address - Phone:508-279-1366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH10889124Q00000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No124Q00000XDental ProvidersDental Hygienist