Provider Demographics
NPI:1902966583
Name:BENSON DENTAL GROUP, LLC
Entity Type:Organization
Organization Name:BENSON DENTAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/MANAGER OF COMPANY
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:BAGLEY
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-394-3114
Mailing Address - Street 1:800 MOUNT VERNON HWY NE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4295
Mailing Address - Country:US
Mailing Address - Phone:770-394-3114
Mailing Address - Fax:770-394-3343
Practice Address - Street 1:800 MT. VERNON HIGHWAY
Practice Address - Street 2:SUITE 405
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4293
Practice Address - Country:US
Practice Address - Phone:770-394-3114
Practice Address - Fax:770-394-3343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA88361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty