Healthcare Provider Details

I. General information

NPI: 1780388413
Provider Name (Legal Business Name): JENNA NICOLE BENSON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 GARDNER RD STE C
CHARLESTON SC
29407-5747
US

IV. Provider business mailing address

1051 GARDNER RD STE C
CHARLESTON SC
29407-5747
US

V. Phone/Fax

Practice location:
  • Phone: 843-588-5115
  • Fax:
Mailing address:
  • Phone: 843-588-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10728
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: