Healthcare Provider Details

I. General information

NPI: 1255712675
Provider Name (Legal Business Name): JAMES ROBERT BENSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 KEILY STREET BUMED
JACKSONVILLE FL
32212
US

IV. Provider business mailing address

734 KEILY STREET BUMED
JACKSONVILLE FL
32212
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-7011
  • Fax:
Mailing address:
  • Phone: 757-953-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2015017915
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS043394
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: