Healthcare Provider Details

I. General information

NPI: 1285054304
Provider Name (Legal Business Name): LANE A BENSON RDH,PHDHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S MADISON ST
ALLENTOWN PA
18102-4636
US

IV. Provider business mailing address

106 S MADISON ST
ALLENTOWN PA
18102-4636
US

V. Phone/Fax

Practice location:
  • Phone: 484-542-1891
  • Fax: 208-439-1637
Mailing address:
  • Phone: 484-542-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberPHDH00321
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: