MEDICARE: PATRICIA BENTON D.M.D.

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	122300000X	Dentist	10081098	MA
2	1223P0221X	Pediatric Dentistry	D9593	OR
3	1223P0221X	Pediatric Dentistry	DE60404303	WA

General Provider Information

NPI Number	:	1861656738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA BENTON D.M.D.

Provider Business Mailing Address
First Line	:	4422 BAGLEY AVE N
Second Line	:	APT #104
City	:	SEATTLE
State	:	WA
Zip	:	98103-7677
Country	:	US
Telephone Number	:	253-691-1533
Fax Number	:

Provider Business Practice Location Address
First Line	:	3519 56TH ST NW
Second Line	:	140
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-8593
Country	:	US
Telephone Number	:	253-858-8581
Fax Number	:

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

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	12/30/2013

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