Provider Demographics
NPI:1710295092
Name:CHESEBRO, BEN RONALD (DMD)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:RONALD
Last Name:CHESEBRO
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 1:2508 E FOX FARM RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-2559
Mailing Address - Country:US
Mailing Address - Phone:307-635-3618
Mailing Address - Fax:307-635-1442
Practice Address - Street 1:2508 E FOX FARM RD STE 1A
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-2559
Practice Address - Country:US
Practice Address - Phone:307-635-3618
Practice Address - Fax:307-635-1442
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice