Provider Demographics
NPI:1871159681
Name:BENSON, CHASE ALAN (DMD)
Entity type:Individual
Prefix:DR
First Name:CHASE
Middle Name:ALAN
Last Name:BENSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-4928
Mailing Address - Country:US
Mailing Address - Phone:208-788-0048
Mailing Address - Fax:
Practice Address - Street 1:14 E ELM ST
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-4928
Practice Address - Country:US
Practice Address - Phone:208-788-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-52401223G0001X
UT1126613299221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice