Provider Demographics
NPI:1407868177
Name:ANDERSON, BENJAMIN A (DDS)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:A
Last Name:ANDERSON
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 1:300 E LITTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-2603
Mailing Address - Country:US
Mailing Address - Phone:757-587-6453
Mailing Address - Fax:757-587-2021
Practice Address - Street 1:300 E LITTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-2603
Practice Address - Country:US
Practice Address - Phone:757-587-6453
Practice Address - Fax:757-587-2021
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014105041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice