Provider Demographics
NPI:1346431798
Name:WARREN, BENJAMIN (DMD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:WARREN
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:PO BOX 1901
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-1901
Mailing Address - Country:US
Mailing Address - Phone:907-966-8343
Mailing Address - Fax:
Practice Address - Street 1:222 TONGASS DR.
Practice Address - Street 2:SEARHC - DENTAL DEPARTMENT
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-1901
Practice Address - Country:US
Practice Address - Phone:907-966-8343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA94751223G0001X
WV38441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice