Provider Demographics
NPI:1326359720
Name:PHILLIPS, BENJAMIN G (DDS)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:G
Last Name:PHILLIPS
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 1:246 BILLINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:HERMON
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-848-3384
Mailing Address - Fax:207-848-9012
Practice Address - Street 1:246 BILLINGS ROAD
Practice Address - Street 2:
Practice Address - City:HERMON
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-848-3384
Practice Address - Fax:207-848-9012
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4141122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist