Provider Demographics
NPI:1679758072
Name:BENSON, JESTINA O (DDS)
Entity type:Individual
Prefix:
First Name:JESTINA
Middle Name:O
Last Name:BENSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 STEEPLE CHASE DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4053
Mailing Address - Country:US
Mailing Address - Phone:410-535-0296
Mailing Address - Fax:410-535-4707
Practice Address - Street 1:205 STEEPLE CHASE DR
Practice Address - Street 2:SUITE 208
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4053
Practice Address - Country:US
Practice Address - Phone:410-535-0296
Practice Address - Fax:410-535-4707
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD140171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice