Provider Demographics
NPI:1902919152
Name:BENSON, JEFFREY ALAN (DMD , MSD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:BENSON
Suffix:
Gender:M
Credentials:DMD , MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3959 TULIP TREE DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4736
Mailing Address - Country:US
Mailing Address - Phone:814-866-1207
Mailing Address - Fax:
Practice Address - Street 1:2141 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4764
Practice Address - Country:US
Practice Address - Phone:814-459-2442
Practice Address - Fax:814-452-3484
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022718L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics