Provider Demographics
NPI:1679585756
Name:PO, BENJAMIN TY JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:TY
Last Name:PO
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:32003 WENDT PARK TRCE
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-4187
Mailing Address - Country:US
Mailing Address - Phone:281-346-0640
Mailing Address - Fax:
Practice Address - Street 1:2840 COMMERCIAL CENTER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6411
Practice Address - Country:US
Practice Address - Phone:281-693-9100
Practice Address - Fax:281-693-9101
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX148851223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry