Provider Demographics
NPI:1063821643
Name:WERNER, BENJAMIN EUGENE (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:EUGENE
Last Name:WERNER
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 1:6151 S REDWOOD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5332
Mailing Address - Country:US
Mailing Address - Phone:801-441-2144
Mailing Address - Fax:
Practice Address - Street 1:6151 S REDWOOD RD STE 200
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5332
Practice Address - Country:US
Practice Address - Phone:801-441-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009016122300000X
KS621921223P0221X
UT12787368-99241223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist