Provider Demographics
NPI:1568991602
Name:SITZ, BENJAMIN WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:WILLIAM
Last Name:SITZ
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 1:406 PLEASANT AVE S
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-1428
Mailing Address - Country:US
Mailing Address - Phone:218-252-0139
Mailing Address - Fax:
Practice Address - Street 1:406 PLEASANT AVE S
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1428
Practice Address - Country:US
Practice Address - Phone:218-237-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-11
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND138351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice