Healthcare Provider Details

I. General information

NPI: 1225031859
Provider Name (Legal Business Name): DONALD ROBERT BENSCHOTER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/25/2006
Reactivation Date: 04/11/2006

III. Provider practice location address

1100 SOUTHGATE SUITE 17
PENDLETON OR
97801
US

IV. Provider business mailing address

1100 SOUTHGATE SUITE 17
PENDLETON OR
97801
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-1561
  • Fax: 541-276-5743
Mailing address:
  • Phone: 541-276-1561
  • Fax: 541-276-5743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5269
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: