Healthcare Provider Details

I. General information

NPI: 1235403791
Provider Name (Legal Business Name): BENSON & BENSON FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 VINCENT ST
SMITHS GROVE KY
42171
US

IV. Provider business mailing address

PO BOX 370
SMITHS GROVE KY
42171-0370
US

V. Phone/Fax

Practice location:
  • Phone: 270-563-4706
  • Fax: 270-563-4819
Mailing address:
  • Phone: 270-563-4706
  • Fax: 270-563-4819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4850
License Number StateKY

VIII. Authorized Official

Name: DR. MARY H BENSON
Title or Position: PARTNER
Credential: DMD
Phone: 270-563-4819