Provider Demographics
NPI:1134605728
Name:COENEN, BENJAMIN LAPKE (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:LAPKE
Last Name:COENEN
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 1:167 REVOLUTION DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7877
Mailing Address - Country:US
Mailing Address - Phone:402-960-7813
Mailing Address - Fax:
Practice Address - Street 1:996 TANNER FORD BLVD
Practice Address - Street 2:
Practice Address - City:HANAHAN
Practice Address - State:SC
Practice Address - Zip Code:29410-4780
Practice Address - Country:US
Practice Address - Phone:843-973-8236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC108901223S0112X
MO2019013189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery