Provider Demographics
NPI:1023495637
Name:SHIMEL, BENJAMIN RYAN (DDS)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:RYAN
Last Name:SHIMEL
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 1:111 DEERWOOD RD STE 130
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-2194
Mailing Address - Country:US
Mailing Address - Phone:925-217-4884
Mailing Address - Fax:
Practice Address - Street 1:111 DEERWOOD RD STE 130
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-2194
Practice Address - Country:US
Practice Address - Phone:925-217-4884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA643891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery