Organization
BENSON ORAL SURGERY AND DENTAL IMPLANTS, LLC
Active
Organization
BENSON ORAL SURGERY AND DENTAL IMPLANTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY STEVEN BENSON DDS (OWNER)
(219) 879-8710
Entity
Organization
Contact information
Practice address
8809 W 400 N, SUITE 2, MICHIGAN CITY, IN 46360-9330
(219) 879-8710
Mailing address
8809 W 400 N, SUITE 2, MICHIGAN CITY, IN 46360-9330
(219) 879-8710
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
12011706A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201031920A
—
IN
05
—
33791200
—
WI
Enumeration date
04/24/2012
Last updated
04/24/2012
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