Provider Demographics
NPI:1083272116
Name:JOHNSON, BENJAMIN MYERS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:MYERS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 RIDGEWORTH CT
Mailing Address - Street 2:
Mailing Address - City:SOPHIA
Mailing Address - State:NC
Mailing Address - Zip Code:27350-8636
Mailing Address - Country:US
Mailing Address - Phone:336-420-8668
Mailing Address - Fax:
Practice Address - Street 1:1706 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-2646
Practice Address - Country:US
Practice Address - Phone:336-884-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC114031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice