Provider Demographics
NPI:1033223094
Name:GARR, BENJAMIN L (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:L
Last Name:GARR
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:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:CARRINGTON
Mailing Address - State:ND
Mailing Address - Zip Code:58421-0537
Mailing Address - Country:US
Mailing Address - Phone:701-652-2300
Mailing Address - Fax:701-652-2303
Practice Address - Street 1:740 4TH AVE S STE 201
Practice Address - Street 2:
Practice Address - City:CARRINGTON
Practice Address - State:ND
Practice Address - Zip Code:58421-2321
Practice Address - Country:US
Practice Address - Phone:701-652-2300
Practice Address - Fax:701-652-2303
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5927687-9922122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist