Provider Demographics
NPI:1568696540
Name:DESMOND, BENJAMAN RAY (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:
First Name:BENJAMAN
Middle Name:RAY
Last Name:DESMOND
Suffix:
Gender:M
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-1531
Mailing Address - Country:US
Mailing Address - Phone:207-443-9721
Mailing Address - Fax:207-443-9722
Practice Address - Street 1:171 CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-1531
Practice Address - Country:US
Practice Address - Phone:207-443-9721
Practice Address - Fax:207-443-9722
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH3603124Q00000X
124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist