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General NPI Number Information
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NPI Number | 1760091763
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Entity Type | Organization
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Legal Business Name | ERIE CANAL DENTAL PLLC
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Dates
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Enumeration Date | 07/26/2020
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Last Update Date | 07/26/2020
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Provider Practice Location Address
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Address Line | 91 ERIE CANAL DR STE A
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City | ROCHESTER
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State | NY
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Zip | 14626-4603
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Country | US
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Telephone | 585-754-2250
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Fax |
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Provider Business Mailing Address
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Address Line | 6 SKIDMORE DR
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City | SPENCERPORT
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State | NY
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Zip | 14559-9535
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Country | US
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Telephone | 415-694-0819
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. ERIC BENSON
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Credential | DDS
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Telephone | 415-694-0819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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