Healthcare Provider Details

I. General information

NPI: 1952578411
Provider Name (Legal Business Name): DAVID ANDREW BENSON DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 S VAL VISTA DR STE 164
GILBERT AZ
85295-1638
US

IV. Provider business mailing address

560 E RAVEN CT
GILBERT AZ
85297-1207
US

V. Phone/Fax

Practice location:
  • Phone: 480-855-3223
  • Fax: 480-855-1229
Mailing address:
  • Phone: 318-426-0379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD008709
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: