Provider Demographics
NPI:1548393507
Name:BENHAM, KENT JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:JAMES
Last Name:BENHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49238-0186
Mailing Address - Country:US
Mailing Address - Phone:517-447-4123
Mailing Address - Fax:
Practice Address - Street 1:164 RAISIN ST
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:MI
Practice Address - Zip Code:49238-9717
Practice Address - Country:US
Practice Address - Phone:517-447-4123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010158091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice