Provider Demographics
NPI:1578910998
Name:NOBLITT, BENJAMIN R (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:R
Last Name:NOBLITT
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 1:2101 GRANDIN RD APT 220
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-3342
Mailing Address - Country:US
Mailing Address - Phone:425-293-1372
Mailing Address - Fax:
Practice Address - Street 1:7020 60TH PL NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-8919
Practice Address - Country:US
Practice Address - Phone:425-293-1372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program