Provider Demographics
NPI:1679550602
Name:BENNION, DAVID ANDERSON (DMD MS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDERSON
Last Name:BENNION
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:ANDY
Other - Middle Name:
Other - Last Name:BENNION
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD MS
Mailing Address - Street 1:2233-A WILLAMETTE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405
Mailing Address - Country:US
Mailing Address - Phone:541-687-1151
Mailing Address - Fax:541-345-0126
Practice Address - Street 1:2233-A WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405
Practice Address - Country:US
Practice Address - Phone:541-687-1151
Practice Address - Fax:541-345-0126
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD73671223X0400X, 122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment