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General NPI Number Information
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NPI Number | 1861656738
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Entity Type | Individual
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Provider Name | PATRICIA BENTON D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 12/30/2013
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Provider Practice Location Address
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Address Line | 3519 56TH ST NW 140
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City | GIG HARBOR
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State | WA
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Zip | 98335-8593
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Country | US
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Telephone | 253-858-8581
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Fax |
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Provider Business Mailing Address
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Address Line | 4422 BAGLEY AVE N APT #104
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City | SEATTLE
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State | WA
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Zip | 98103-7677
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Country | US
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Telephone | 253-691-1533
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10081098
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D9593
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DE60404303
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License Number State | WA
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