Provider Demographics
NPI:1902866239
Name:BENIAN, RICHARD MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MICHAEL
Last Name:BENIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:11525 HIGHLAND RD
Mailing Address - Street 2:SUITE 23
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353-2726
Mailing Address - Country:US
Mailing Address - Phone:810-632-7257
Mailing Address - Fax:810-632-7305
Practice Address - Street 1:9880 E GRAND RIVER AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2468
Practice Address - Country:US
Practice Address - Phone:810-227-2626
Practice Address - Fax:810-227-8532
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI146561223S0112X
MIRB014656204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI190F37120OtherBLUECROSS MEDICAL PIN NUM
MIP103067OtherBLUE CRSS NETWORK NUMBER
MID802670OtherBLUE CROSS DENTAL
MIP103067OtherBLUE CRSS NETWORK NUMBER
MID802670OtherBLUE CROSS DENTAL
MIOF3710004Medicare ID - Type UnspecifiedWATERFORD/MILFORD