Healthcare Provider Details

I. General information

NPI: 1023503109
Provider Name (Legal Business Name): ASHLEY ELIZABETH BENSEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 E US HIGHWAY 36
AVON IN
46123-7156
US

IV. Provider business mailing address

7800 E US HIGHWAY 36
AVON IN
46123-7156
US

V. Phone/Fax

Practice location:
  • Phone: 317-272-2700
  • Fax: 317-272-2785
Mailing address:
  • Phone: 317-272-2700
  • Fax: 317-272-2785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12012977A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: