=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760653125
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BENSTON DANIEL JOHNSON DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2008
-----------------------------------------------------
Last Update Date | 07/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6633 FOREST AVE SUITE 105
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34653-2612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-845-4300
-----------------------------------------------------
Fax | 813-635-7834
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12310 CRESTRIDGE LOOP
-----------------------------------------------------
City | TRINITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34655-0028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-373-8678
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | OS10941
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------