Provider Demographics
NPI:1558540575
Name:REESE, BENJAMIN ERIC (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ERIC
Last Name:REESE
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 W COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-2814
Mailing Address - Country:US
Mailing Address - Phone:317-408-0336
Mailing Address - Fax:
Practice Address - Street 1:5880 NE CORNELL RD
Practice Address - Street 2:SUITE D
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9075
Practice Address - Country:US
Practice Address - Phone:503-615-8600
Practice Address - Fax:503-681-8691
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD90051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics