Healthcare Provider Details

I. General information

NPI: 1770972101
Provider Name (Legal Business Name): DIANNE BENEDICTSON DDS, NC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 LAUREL LANE
CHESTER CA
96020
US

IV. Provider business mailing address

211 LAUREL LANE
CHESTER CA
96020
US

V. Phone/Fax

Practice location:
  • Phone: 530-258-2201
  • Fax: 530-258-3134
Mailing address:
  • Phone: 530-258-2201
  • Fax: 530-258-3134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number41229
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: