Provider Demographics
NPI:1003064056
Name:BENSON, NICOLE L (DDS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
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 1:8620 SKILLMAN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-8216
Mailing Address - Country:US
Mailing Address - Phone:214-341-0900
Mailing Address - Fax:214-580-5202
Practice Address - Street 1:8620 SKILLMAN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-8216
Practice Address - Country:US
Practice Address - Phone:214-341-0900
Practice Address - Fax:214-580-5202
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23432122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist