Provider Demographics
NPI:1265090260
Name:SOWLE, BENJAMIN PATRICK (DMD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:PATRICK
Last Name:SOWLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 PEACHTREE DR
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-8058
Mailing Address - Country:US
Mailing Address - Phone:217-414-4919
Mailing Address - Fax:
Practice Address - Street 1:1401 N ALLEN ST
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-1003
Practice Address - Country:US
Practice Address - Phone:618-546-1544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0321531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice