MEDICARE: DAVID ANDREW BENSON, DDS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DEN.00203329	CO

General Provider Information

NPI Number	:	1467964858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID ANDREW BENSON, DDS, PLLC

Provider Business Mailing Address
First Line	:	111 LABELLE LN
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71115-2964
Country	:	US
Telephone Number	:	318-426-0379
Fax Number	:

Provider Business Practice Location Address
First Line	:	6160 TUTT BLVD STE 250
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-1500
Country	:	US
Telephone Number	:	719-359-8652
Fax Number	:	719-623-5771

Authorized Official
Title or Position	:	ORAL SURGEON
Name	:	DR. DAVID ANDREW BENSON
Credential	:	DDS, MD
Telephone Number	:	318-426-0379

Provider Enumeration Date	:	10/25/2017
Last Update Date	:	10/25/2017

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