Provider Demographics
NPI:1891831137
Name:BENJAMIN, RICHARD N
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:N
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:N
Other - Last Name:BENJAMIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:907 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:PROSPECT PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19076-1414
Mailing Address - Country:US
Mailing Address - Phone:610-583-5052
Mailing Address - Fax:610-583-5081
Practice Address - Street 1:907 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:PA
Practice Address - Zip Code:19076-1414
Practice Address - Country:US
Practice Address - Phone:610-583-5052
Practice Address - Fax:610-583-5081
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018308L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice