Provider Demographics
NPI:1497850861
Name:RICHARDS, BENJAMIN JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JOHN
Last Name:RICHARDS
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 1:17 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-3219
Mailing Address - Country:US
Mailing Address - Phone:910-353-5234
Mailing Address - Fax:910-353-1999
Practice Address - Street 1:17 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-3219
Practice Address - Country:US
Practice Address - Phone:910-353-5234
Practice Address - Fax:910-353-1999
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC90011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics