Healthcare Provider Details

I. General information

NPI: 1295777688
Provider Name (Legal Business Name): SCOTT D BENJAMIN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 UNION ST
SIDNEY NY
13838-1430
US

IV. Provider business mailing address

PO BOX 27
SIDNEY NY
13838-0027
US

V. Phone/Fax

Practice location:
  • Phone: 607-563-2333
  • Fax:
Mailing address:
  • Phone: 607-563-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number033878
License Number StateNY

VIII. Authorized Official

Name: DR. SCOTT D BENJAMIN
Title or Position: PRESIDENT
Credential: DDS
Phone: 607-563-2333