Provider Demographics
NPI:1619560257
Name:BEN DANIEL DMD, PA
Entity Type:Organization
Organization Name:BEN DANIEL DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-254-6414
Mailing Address - Street 1:2104B WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5941
Mailing Address - Country:US
Mailing Address - Phone:864-254-6414
Mailing Address - Fax:864-254-6454
Practice Address - Street 1:2104B WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5941
Practice Address - Country:US
Practice Address - Phone:864-254-6414
Practice Address - Fax:864-254-6454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental