Provider Demographics
NPI:1952442733
Name:BER, BENJAMIN S (DDS ,MS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:S
Last Name:BER
Suffix:
Gender:M
Credentials:DDS ,MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:761 W TUNNEL BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-5545
Mailing Address - Country:US
Mailing Address - Phone:985-917-0084
Mailing Address - Fax:985-917-0086
Practice Address - Street 1:761 WEST TUNNEL BOULEVARD
Practice Address - Street 2:E
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360
Practice Address - Country:US
Practice Address - Phone:985-917-0084
Practice Address - Fax:985-917-0086
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA53861223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics