Healthcare Provider Details

I. General information

NPI: 1679550602
Provider Name (Legal Business Name): DAVID ANDERSON BENNION DMD MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ANDY BENNION DMD MS

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233-A WILLAMETTE ST
EUGENE OR
97405
US

IV. Provider business mailing address

2233-A WILLAMETTE ST
EUGENE OR
97405
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-1151
  • Fax: 541-345-0126
Mailing address:
  • Phone: 541-687-1151
  • Fax: 541-345-0126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD7367
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD7367
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: