Provider Demographics
NPI:1760732580
Name:BENJAMIN DORANTES DDS PLLC
Entity Type:Organization
Organization Name:BENJAMIN DORANTES DDS PLLC
Other - Org Name:LAKEVIEW DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DORANTES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-380-3885
Mailing Address - Street 1:5710 BOTHELL WAY NE
Mailing Address - Street 2:STE. 5
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028
Mailing Address - Country:US
Mailing Address - Phone:425-488-1405
Mailing Address - Fax:
Practice Address - Street 1:5710 BOTHELL WAY NE
Practice Address - Street 2:STE. 5
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028
Practice Address - Country:US
Practice Address - Phone:425-488-1405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1223G0001X1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty