Provider Demographics
NPI:1164978672
Name:HALPERN, BENJAMIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:HALPERN
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 1:299 JUANA AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4838
Mailing Address - Country:US
Mailing Address - Phone:510-352-6266
Mailing Address - Fax:
Practice Address - Street 1:299 JUANA AVE STE C
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4838
Practice Address - Country:US
Practice Address - Phone:510-352-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2022-08-15
Deactivation Date:2019-09-16
Deactivation Code:
Reactivation Date:2019-09-25
Provider Licenses
StateLicense IDTaxonomies
CADDS1006661223P0300X
MND143001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics