Healthcare Provider Details

I. General information

NPI: 1265662977
Provider Name (Legal Business Name): KIMBERLY BENSONHAVER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LAWS AVE
UKIAH CA
95482-6540
US

IV. Provider business mailing address

333 LAWS AVE
UKIAH CA
95482-6540
US

V. Phone/Fax

Practice location:
  • Phone: 707-468-1010
  • Fax: 707-462-7532
Mailing address:
  • Phone: 707-468-1010
  • Fax: 707-462-7532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number109419
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number4636
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: