Provider Demographics
NPI:1356688501
Name:BENAGE, ANNEMARIE JOHNSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNEMARIE
Middle Name:JOHNSON
Last Name:BENAGE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 E SNIDER DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7604
Mailing Address - Country:US
Mailing Address - Phone:907-376-8400
Mailing Address - Fax:
Practice Address - Street 1:4501 E SNIDER DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7604
Practice Address - Country:US
Practice Address - Phone:907-376-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1470122300000X
TX27973122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist