Provider Demographics
NPI:1659444248
Name:GRIEB, BENJAMIN TODD (DMD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:TODD
Last Name:GRIEB
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 1:155 SW SHEVLIN HIXON DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3174
Mailing Address - Country:US
Mailing Address - Phone:541-382-0392
Mailing Address - Fax:541-383-7170
Practice Address - Street 1:155 SW SHEVLIN HIXON DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3174
Practice Address - Country:US
Practice Address - Phone:541-382-0392
Practice Address - Fax:541-383-7170
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD83111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice