Provider Demographics
NPI:1336364744
Name:BENSON, BRUCE ALLEN (DMD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:ALLEN
Last Name:BENSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 37TH STREET
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-5733
Mailing Address - Country:US
Mailing Address - Phone:605-339-3222
Mailing Address - Fax:605-339-7031
Practice Address - Street 1:101 W 37TH STREET
Practice Address - Street 2:SUITE 110
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-5733
Practice Address - Country:US
Practice Address - Phone:605-339-3222
Practice Address - Fax:605-339-7031
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM7401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice