Provider Demographics
NPI:1942377239
Name:LAUDIG, BENJAMIN IAN (DDS)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:IAN
Last Name:LAUDIG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 4TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-5716
Mailing Address - Country:US
Mailing Address - Phone:415-473-5454
Mailing Address - Fax:415-473-5460
Practice Address - Street 1:411 4TH ST STE C
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-5716
Practice Address - Country:US
Practice Address - Phone:415-473-5454
Practice Address - Fax:415-473-5460
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550081223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health