Provider Demographics
NPI:1003935552
Name:DONGIEUX, BENJAMIN PATRICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:PATRICK
Last Name:DONGIEUX
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 1:3500 DULUTH PARK LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3242
Mailing Address - Country:US
Mailing Address - Phone:770-623-6714
Mailing Address - Fax:
Practice Address - Street 1:3500 DULUTH PARK LN
Practice Address - Street 2:SUITE 100
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3242
Practice Address - Country:US
Practice Address - Phone:770-623-6714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0107711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice