Healthcare Provider Details

I. General information

NPI: 1003214305
Provider Name (Legal Business Name): SAOLY BENSON DDS MS PROF. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2014
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5980 S DURANGO DR STE 124
LAS VEGAS NV
89113-1775
US

IV. Provider business mailing address

1452 W HORIZON RIDGE PKWY # 653
HENDERSON NV
89012-4422
US

V. Phone/Fax

Practice location:
  • Phone: 702-800-4698
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-272
License Number StateNV

VIII. Authorized Official

Name: DR. SAOLY BENSON
Title or Position: ORTHODONTIST
Credential: D.D.S., M.S.
Phone: 253-985-3120