Provider Demographics
NPI:1285054304
Name:BENSON, LANE A (RDH,PHDHP)
Entity type:Individual
Prefix:
First Name:LANE
Middle Name:A
Last Name:BENSON
Suffix:
Gender:F
Credentials:RDH,PHDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-4636
Mailing Address - Country:US
Mailing Address - Phone:484-542-1891
Mailing Address - Fax:
Practice Address - Street 1:106 S MADISON ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-4636
Practice Address - Country:US
Practice Address - Phone:484-542-1891
Practice Address - Fax:208-439-1637
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPHDH00321124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist