Provider Demographics
NPI:1881719920
Name:BENGTSON, STEVEN R (DMD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:BENGTSON
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 1:16 WALL ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3743
Mailing Address - Country:US
Mailing Address - Phone:603-228-3384
Mailing Address - Fax:603-228-3366
Practice Address - Street 1:16 WALL ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3743
Practice Address - Country:US
Practice Address - Phone:603-228-3384
Practice Address - Fax:603-228-3366
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH20991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30313381Medicaid