Charles Deon Benson
Individual provider Active NPI General Practice Dentistry · Smiths Grove, KY
NPI 1609948462 · NPPES record last updated Jan 23, 2008
Key facts
- NPI
- 1609948462
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 4849 (KY)
- Practice address
- 148 Vincent Street
P O 370
Smiths Grove, KY 42171 - Phone
- (270) 563-4706
- Fax
- (270) 563-4819
- NPI assigned
- Nov 15, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4849 | KY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Benson & Benson Family Dentistry | General Practice | Past | Accepting new patients |
| Smiths Grove Family Dentistry | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4849 | KY | Yes |
| Dentist | 122300000X | 4849 | KY |
Addresses
Primary practice location
148 Vincent Street
P O 370
Smiths Grove, KY 42171
Mailing address
148 Vincent St
P O 370
Smiths Grove, KY 42171
Phone (270) 563-4706
Other names
- Mary H Benson
Other providers in Smiths Grove, KY
- Arrive Alive
- Pravin N Avula
- Shazmeena Bangash
- April D. Basham
- Benson & Benson Family Dentistry
- Mary H Benson
- Amy Pendleton Brown
- Molly Sullivan Bylsma
- Bailey Ann Canchola
- Care2U, LLC
All providers in Smiths Grove, KY · General Practice Dentistry in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 23, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.