Provider Demographics
NPI:1518039379
Name:BENSON, MARY H (DMD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:H
Last Name:BENSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:DEON
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:148 VINCENT STREET
Mailing Address - Street 2:PO 370
Mailing Address - City:SMITHS GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:42171
Mailing Address - Country:US
Mailing Address - Phone:270-563-4706
Mailing Address - Fax:270-563-4819
Practice Address - Street 1:148 VINCENT STREET
Practice Address - Street 2:PO 370
Practice Address - City:SMITHS GROVE
Practice Address - State:KY
Practice Address - Zip Code:42171
Practice Address - Country:US
Practice Address - Phone:270-563-4706
Practice Address - Fax:270-563-4819
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice