Provider Demographics
NPI:1528448529
Name:BENCA, LAURA (DDS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BENCA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 NE BLAKELEY ST APT 211
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3160
Mailing Address - Country:US
Mailing Address - Phone:206-919-9701
Mailing Address - Fax:
Practice Address - Street 1:2901 NE BLAKELEY ST APT 211
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3160
Practice Address - Country:US
Practice Address - Phone:206-919-9701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60560274122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist