MEDICARE: DR. DAVID ALLEN BENSON D.D.S.

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	1223G0001X	General Practice Dentistry	23708	CA

General Provider Information

NPI Number	:	1700880044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ALLEN BENSON D.D.S.

Provider Business Mailing Address
First Line	:	3316 LAS HUERTAS ROAD
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2229 REGENT ST.
Second Line	:	SUITE 502
City	:	BERKELEY
State	:	CA
Zip	:	94705-2146
Country	:	US
Telephone Number	:	510-843-0451
Fax Number	:	510-843-0455

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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