Wakeshi Lanise Benson, DDS

Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · Chester, VA

NPI 1760675227 · NPPES record last updated May 8, 2014

Key facts

NPI
1760675227
Entity type
Individual (NPI type 1)
Primary specialty
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
License
0401411415 (VA)
Practice address
12230 Iron Bridge Rd
Suite B
Chester, VA 23831-1534
Phone
(804) 454-1888
Fax
(804) 454-1868
NPI assigned
Aug 19, 2007
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
2901017909MIMDDentist
0401411415VAMDOrthodontics and Dentofacial Orthopedic Dentist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2901017909 MI
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 0401411415 VA Yes

Addresses

Primary practice location

12230 Iron Bridge Rd
Suite B
Chester, VA 23831-1534

Mailing address

12230 Iron Bridge Rd
Suite B
Chester, VA 23831-1534
Phone (804) 454-1888

Other providers in Chester, VA

All providers in Chester, VA · Orthodontics and Dentofacial Orthopedics Dentistry in Virginia

Sources for this page

Verify at the official NPI Registry.