Provider Demographics
NPI:1114670106
Name:BENJAMIN H FISHBEIN DDS PL
Entity Type:Organization
Organization Name:BENJAMIN H FISHBEIN DDS PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AVERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LORSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-477-1089
Mailing Address - Street 1:4900 MARKET PLACE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8985
Mailing Address - Country:US
Mailing Address - Phone:850-477-1089
Mailing Address - Fax:850-479-3548
Practice Address - Street 1:4900 MARKET PLACE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8985
Practice Address - Country:US
Practice Address - Phone:850-477-1089
Practice Address - Fax:850-479-3548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty