Provider Demographics
NPI:1316923964
Name:BENSON, DEAN L (MPAC)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:L
Last Name:BENSON
Suffix:
Gender:
Credentials:MPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-1514
Mailing Address - Country:US
Mailing Address - Phone:402-336-2611
Mailing Address - Fax:402-336-5137
Practice Address - Street 1:300 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-1514
Practice Address - Country:US
Practice Address - Phone:402-336-2611
Practice Address - Fax:402-336-5137
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE632363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47046391112Medicaid
NE281763Medicare PIN
NER85557Medicare UPIN