Healthcare Provider Details

I. General information

NPI: 1326099458
Provider Name (Legal Business Name): KENNETH J. BENSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 CREEDMOOR RD
RALEIGH NC
27613-1640
US

IV. Provider business mailing address

7401 CREEDMOOR RD
RALEIGH NC
27613-1640
US

V. Phone/Fax

Practice location:
  • Phone: 919-622-2035
  • Fax: 919-846-3550
Mailing address:
  • Phone: 919-622-2035
  • Fax: 919-846-3550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6621
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: