Provider Demographics
NPI:1518061845
Name:JOHNSON, BENJAMIN PATRICK (DDS)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:PATRICK
Last Name:JOHNSON
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 1:8808 STONEHILL CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066
Mailing Address - Country:US
Mailing Address - Phone:937-825-0382
Mailing Address - Fax:
Practice Address - Street 1:321 N BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042
Practice Address - Country:US
Practice Address - Phone:513-424-3971
Practice Address - Fax:513-422-2902
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH22148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH22148OtherLICENSE