Provider Demographics
NPI:1306729181
Name:BENSO GOLD DENTAL, P.A.
Entity type:Organization
Organization Name:BENSO GOLD DENTAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-653-3333
Mailing Address - Street 1:571 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-2605
Mailing Address - Country:US
Mailing Address - Phone:904-653-3333
Mailing Address - Fax:904-653-3333
Practice Address - Street 1:571 S 6TH ST
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-2605
Practice Address - Country:US
Practice Address - Phone:904-653-3333
Practice Address - Fax:904-653-3333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENSO GOLD DENTAL, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-29
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental