Provider Demographics
NPI:1952578411
Name:BENSON, DAVID ANDREW (DDS, MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:BENSON
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 E RAVEN CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-1207
Mailing Address - Country:US
Mailing Address - Phone:318-426-0379
Mailing Address - Fax:
Practice Address - Street 1:2680 S VAL VISTA DR STE 164
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1638
Practice Address - Country:US
Practice Address - Phone:480-855-3223
Practice Address - Fax:480-855-1229
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0087091223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery