Healthcare Provider Details

I. General information

NPI: 1649854373
Provider Name (Legal Business Name): KINGSLEY KOFI BENSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 CALLE DE NINOS
LAS CRUCES NM
88005-3293
US

IV. Provider business mailing address

2000 SATELLITE POINTE APT 2303
DULUTH GA
30096-5651
US

V. Phone/Fax

Practice location:
  • Phone: 575-526-5522
  • Fax:
Mailing address:
  • Phone: 404-931-4856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDB-2026-0320
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN123576
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number108003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: