Provider Demographics
NPI:1750670014
Name:JOHNSON, BENJAMIN SINGER (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:SINGER
Last Name:JOHNSON
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 1:4027 N BARTLETT AVE
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1909
Mailing Address - Country:US
Mailing Address - Phone:617-803-3731
Mailing Address - Fax:
Practice Address - Street 1:4027 N BARTLETT AVE
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-1909
Practice Address - Country:US
Practice Address - Phone:617-803-3731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6649-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice