Provider Demographics
NPI:1467645176
Name:SIRCUS, BEN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:A
Last Name:SIRCUS
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 1:7836 OAKWOOD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4244
Mailing Address - Country:US
Mailing Address - Phone:410-766-4650
Mailing Address - Fax:
Practice Address - Street 1:7836 OAKWOOD RD
Practice Address - Street 2:SUITE B
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4244
Practice Address - Country:US
Practice Address - Phone:410-766-4650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD125381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice